Royal Marsden Hospital, London, Surrey, United Kingdom.
Clin Colorectal Cancer. 2011 Dec;10(4):245-57. doi: 10.1016/j.clcc.2011.04.001. Epub 2011 May 10.
Colorectal cancer (CRC) remains a leading cause of cancer death in the developed world. Metastatic disease eventually develops in nearly 50% of patients with CRC. Chemotherapy is the mainstay of treatment in metastatic CRC (mCRC); however the majority of patients remain incurable with current therapeutic options. Progress made in the field of surgery, locoregional treatment for low-volume metastatic disease, and systemic chemotherapy has created new treatment paradigms and improved survival in mCRC. Development of new cytotoxic drugs and the advent of targeted agents over the past decade have seen the median overall survival (OS) for mCRC increase from 9 months to > 2 years. Data from trials integrating targeted therapies appear to indicate that not all have efficacy as single agents and the choice of chemotherapy used in combination with these agents may impact results. Ongoing research is leading to identification of new biomarkers of response, further defining the subpopulations who achieve greatest benefit. Hence optimizing treatment for this group of patients has become increasingly complex, requiring a multidisciplinary approach not only to identify those who are curable with resectable disease but also to determine when it is best to incorporate targeted drugs, with which chemotherapy, and in whom. Currently bevacizumab, cetuximab, and panitumumab are the only approved biologic agents for use in mCRC. In this article we discuss the evidence supporting the use of biologic agents with chemotherapy and suggested strategies for their integration into the treatment armamentarium of mCRC.
结直肠癌（CRC）仍然是发达国家癌症死亡的主要原因。近 50%的 CRC 患者最终会发展为转移性疾病。化疗是转移性 CRC（mCRC）治疗的主要手段；然而，目前的治疗选择中，大多数患者仍然无法治愈。在手术、局部区域治疗小体积转移性疾病以及全身化疗领域取得的进展，为 mCRC 创造了新的治疗模式并改善了生存。在过去十年中，新型细胞毒性药物和靶向药物的发展使 mCRC 的中位总生存期（OS）从 9 个月延长至>2 年。整合靶向治疗的试验数据表明，并非所有药物作为单一药物都有效，并且与这些药物联合使用的化疗药物的选择可能会影响结果。正在进行的研究导致了新的反应生物标志物的鉴定，进一步确定了能够从中获得最大益处的亚群。因此，优化这群患者的治疗方案变得越来越复杂，不仅需要采用多学科方法来识别可通过手术切除治愈的患者，而且还需要确定何时最好将靶向药物与哪种化疗药物联合应用于哪些患者。目前，贝伐单抗、西妥昔单抗和帕尼单抗是唯一批准用于 mCRC 的生物制剂。在本文中，我们讨论了支持将生物制剂与化疗联合使用的证据，并提出了将其整合到 mCRC 治疗武器库中的策略。
