The Queen Elizabeth Hospital and University of Adelaide, Australia.
Clin Colorectal Cancer. 2010 Jan;9(1):8-14. doi: 10.3816/CCC.2010.n.001.
The medical treatment of patients with metastatic colorectal cancer (mCRC) has evolved greatly in the past 10 years, involving complex combined chemotherapy protocols and, in more recent times, new biologic agents. Clinical benefit from the use of the targeted monoclonal antibodies bevacizumab, cetuximab, and panitumumab in the treatment of patients with mCRC is now well-established, but the optimal timing of their use requires careful consideration in order to derive the maximal benefit. Evidence to date suggests potentially distinct roles for bevacizumab and epidermal growth factor receptor-targeted biologic agents (cetuximab and panitumumab) in the treatment of patients with mCRC. This article reviews the evidence in support of modern treatments for mCRC and the decision making behind the treatment choices as well as their benefits and toxicities. An evidence-based algorithm is proposed that incorporates the use of these biologic agents early in the treatment of patients with initially nonresectable mCRC based on clearly defined tumor-related factors dependent on the immediate treatment goal. Real-world application of this algorithm is dependent on an individual countries' approval of access to new biologic agents.
过去 10 年来，转移性结直肠癌（mCRC）患者的治疗方法有了很大的发展，涉及复杂的联合化疗方案，最近又出现了新的生物制剂。在治疗 mCRC 患者时，靶向单克隆抗体贝伐珠单抗、西妥昔单抗和帕尼单抗的临床获益已得到充分证实，但为了获得最大的获益，需要仔细考虑其使用的最佳时机。目前的证据表明，贝伐珠单抗和表皮生长因子受体靶向生物制剂（西妥昔单抗和帕尼单抗）在治疗 mCRC 患者方面可能具有不同的作用。本文回顾了支持 mCRC 现代治疗方法的证据，以及治疗选择背后的决策依据及其获益和毒性。根据明确的肿瘤相关因素，提出了一种基于即时治疗目标的基于证据的算法，该算法将这些生物制剂纳入最初不可切除的 mCRC 患者的早期治疗中。该算法的实际应用取决于各国对获得新生物制剂的批准情况。
