Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
Oncologist. 2018 Jan;23(1):25-34. doi: 10.1634/theoncologist.2017-0203. Epub 2017 Oct 11.
The emergence of targeted therapies for the treatment of metastatic colorectal cancer (mCRC) has considerably improved survival, but has also resulted in a dilemma of identifying the optimal sequence and combination of various agents in the mCRC treatment landscape. A number of cytotoxic agents, including irinotecan, oxaliplatin, 5-fluorouracil, capecitabine, and TAS-102, are available for treatment of mCRC. Additionally, whereas patients harboring rat sarcoma viral oncogene homolog ()-wild type mCRC can be treated with the anti-epidermal growth factor receptor antibodies cetuximab and panitumumab or antiangiogenic agents (bevacizumab, ziv-aflibercept, and ramucirumab), patients with -mutant mCRC are limited to antiangiogenic agents as biologic options. Regorafenib, a multikinase inhibitor, can be used in both subgroups. As such, the recommended sequence of therapies that should be received by each subgroup must also be considered separately. This review provides an overview of recent clinical data for approved and investigational targeted therapies that have been studied across different mCRC treatment lines and patient subgroups. It also examines emerging trends in the treatment landscape for mCRC, including treatment with immune checkpoint inhibitors and the utilization of genomic profiling.
Currently, there are no established guidelines for optimal sequencing of cytotoxic or targeted agents in metastatic colorectal cancer (mCRC). This review provides a snapshot of the current mCRC treatment paradigm and examines the latest clinical data that support the utilization of several targeted agents alone or in combination with backbone chemotherapy across different lines of treatment and patient populations, highlighting recommendations for their usage. Recent advances in the treatment landscape are also summarized, including genomic profiling and preliminary results with immune checkpoint inhibitors.
针对转移性结直肠癌（mCRC）治疗的靶向治疗的出现极大地提高了生存率，但也导致了在 mCRC 治疗领域中确定各种药物最佳顺序和组合的难题。有许多细胞毒性药物，包括伊立替康、奥沙利铂、5-氟尿嘧啶、卡培他滨和 TAS-102，可用于治疗 mCRC。此外，虽然携带鼠肉瘤病毒癌基因同源物（）-野生型 mCRC 的患者可以用抗表皮生长因子受体抗体西妥昔单抗和帕尼单抗或抗血管生成药物（贝伐单抗、ziv-aflibercept 和雷莫芦单抗）治疗，但 -突变型 mCRC 患者只能选择抗血管生成药物作为生物治疗选择。多激酶抑制剂regorafenib 可用于这两个亚组。因此，也必须分别考虑每个亚组应接受的推荐治疗顺序。这篇综述概述了已在不同 mCRC 治疗线和患者亚组中研究的获批和研究性靶向治疗的最新临床数据，还探讨了 mCRC 治疗领域的新兴趋势，包括免疫检查点抑制剂的治疗和基因组分析的应用。
目前，转移性结直肠癌（mCRC）中细胞毒性药物或靶向药物的最佳序贯治疗尚无既定指南。这篇综述提供了当前 mCRC 治疗范例的快照，并检查了支持在不同治疗线和患者人群中单独使用或联合骨干化疗使用几种靶向药物的最新临床数据，强调了其使用建议。还总结了治疗领域的最新进展，包括基因组分析和免疫检查点抑制剂的初步结果。
