Review article: current management of metastatic colorectal cancer - the evolving impact of targeted drug therapies.

BACKGROUND

The field of colorectal cancer chemotherapy has been transformed by the advent of molecule-specific drugs. Combined use of such drugs enhances tumour response rates, but controlled data quantifying the relative efficacy and cost-effectiveness of different drug combinations on overall survival remain scarce.

AIM

To conduct an overview of published clinical trials in advanced colorectal cancer, with the objective of framing provisional approaches to current management.

METHODS

An NCBI/PubMed search was performed using the strings, 'colorectal cancer' ('metastatic' or 'advanced' or 'palliative') and ('chemotherapy' or 'drug therapy' or 'targeted' or 'target-specific' or 'molecularly-targeted').

RESULTS

Combinations of target-specific drugs (with or without the DNA-alkylating agent oxaliplatin) have substantially enhanced colorectal cancer time to progression over the last decade and have also expedited surgical resection of liver metastases. Disease-free survival, overall survival and quality of life are favourably influenced.

CONCLUSIONS

Target-specific drugs improve palliative efficacy in the setting of advanced colorectal cancer. However, key issues persist as to the cost-effectiveness of these newer drug treatments, and further controlled trials are needed to resolve this important debate.