Marwan G. Fakih, Gastrointestinal Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA.
J Clin Oncol. 2015 Jun 1;33(16):1809-24. doi: 10.1200/JCO.2014.59.7633. Epub 2015 Apr 27.
Substantial improvements have been made in the management of metastatic colorectal cancer over the last two decades. The overall survival of patients diagnosed with unresectable metastatic colorectal cancer has increased from approximately 1 year during the era of fluoropyrimidine monotherapy to more than 30 months with the integration of multiple cytotoxic agents and targeted therapies. More effective therapeutic combinations have increased the rate of curative-intent surgical resections, resulting in median survival in this subgroup that exceed 5 years. Here we review the landscape of systemic therapies for unresectable metastatic colorectal cancer during the current era of targeted therapies, review the effects of RAS and BRAF mutations on clinical decision making, and reflect on future directions for the treatment of metastatic colorectal cancer.
在过去的二十年中，转移性结直肠癌的治疗取得了重大进展。不可切除的转移性结直肠癌患者的总体生存率从氟嘧啶单药治疗时代的约 1 年增加到了多种细胞毒性药物和靶向治疗联合应用后的 30 多个月。更有效的治疗组合增加了治愈性手术切除的比率，使得这一亚组的中位生存期超过 5 年。在这里，我们回顾了靶向治疗时代不可切除的转移性结直肠癌的系统治疗现状，回顾了 RAS 和 BRAF 突变对临床决策的影响，并思考了转移性结直肠癌治疗的未来方向。
