Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
World J Gastroenterol. 2013 Dec 14;19(46):8474-88. doi: 10.3748/wjg.v19.i46.8474.
Colorectal cancer (CRC) is a significant health problem, with around 1 million new cases and 500000 deaths every year worldwide. Over the last two decades, the use of novel therapies and more complex treatment strategies have contributed to progressively increase the median survival of patients with unresectable advanced CRC up to approximately 30 mo. The availability of additional therapeutic options, however, has created new challenges and generated more complicated treatment algorithms. Moreover, several clinically important points are still in debate in first-line, such as the optimal treatment intensity, the most appropriate maintenance strategy, the preferred biologic to be used upfront in patients with KRAS wild-type CRC, and the need for more detailed information on tumor biology. In this moving landscape, this review analyses why the first-line treatment decision is crucial and how the choice may impact on further treatment lines. In addition, it focuses on results of major phase III randomized trials.
结直肠癌（CRC）是一个重大的健康问题，全球每年约有 100 万新发病例和 50 万死亡病例。在过去的二十年中，新型治疗方法和更复杂的治疗策略的使用，使得不可切除的晚期 CRC 患者的中位生存期逐渐延长至约 30 个月。然而，更多治疗选择的出现也带来了新的挑战，并产生了更复杂的治疗方案。此外，在一线治疗中，仍有几个临床重要问题存在争议，例如最佳治疗强度、最合适的维持策略、KRAS 野生型 CRC 患者首选的生物制剂，以及对肿瘤生物学更详细信息的需求。在这一动荡的背景下，本文分析了为什么一线治疗决策至关重要，以及这种选择如何影响后续治疗线。此外，本文还重点介绍了主要的 III 期随机临床试验的结果。
