Goldberg Richard M, Rothenberg Mace L, Van Cutsem Eric, Benson Al B, Blanke Charles D, Diasio Robert B, Grothey Axel, Lenz Heinz-Josef, Meropol Neal J, Ramanathan Ramesh K, Becerra Carlos H Roberto, Wickham Rita, Armstrong Delma, Viele Carol
Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Oncologist. 2007 Jan;12(1):38-50. doi: 10.1634/theoncologist.12-1-38.
New agents for the treatment of metastatic colorectal cancer have extended median overall survival to more than 20 months, an increase that has changed the view of advanced colorectal cancer from an acute to a chronic condition. This article proposes a shift in treatment strategy from the concept of successive "lines" of therapy, in which chemotherapy is continued until disease progression, to that of a continuum of care, in which the use of chemotherapy is tailored to the clinical setting and includes switching chemotherapy prior to disease progression, maintenance therapy, drug "holidays," and surgical resection of metastases in selected patients. In this approach, the distinction between lines of therapy is no longer absolute. This represents a paradigm shift in the management of metastatic colorectal cancer to that of a continuum of care approach that includes individualized planning, in which patients are given the opportunity to benefit from exposure to all active agents and modalities while minimizing unnecessary treatment and toxicity, with the ultimate goal of improving survival as well as quality of life.
用于治疗转移性结直肠癌的新型药物已将中位总生存期延长至20多个月，这一增长改变了人们对晚期结直肠癌从急性病到慢性病的看法。本文提出治疗策略应从连续“线”性治疗的概念（即持续化疗直至疾病进展）转变为连续护理的概念，即化疗的使用要根据临床情况进行调整，包括在疾病进展前更换化疗方案、维持治疗、药物“假期”以及对选定患者进行转移灶手术切除。在这种方法中，治疗线之间的区别不再是绝对的。这代表着转移性结直肠癌管理模式向连续护理方法的范式转变，该方法包括个体化规划，即让患者有机会从接触所有活性药物和治疗方式中获益，同时将不必要的治疗和毒性降至最低，最终目标是提高生存率和生活质量。
