Chemotherapy for Colorectal Cancer

Yong Sang Hong; Tae Won Kim

doi:10.5124/jkma.2010.53.7.582

J Korean Med Assoc > Volume 53(7); 2010 > Article

Hong and Kim: Chemotherapy for Colorectal Cancer

Focused Issue of This Month

Colorectal Cancer

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2010; 53(7): 582-591.

Published online: July 06, 2010

DOI: http://dx.doi.org/10.5124/jkma.2010.53.7.582

Chemotherapy for Colorectal Cancer

Yong Sang Hong, MD, Tae Won Kim, MD

Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Tae Won Kim. twkimmd@amc.seoul.kr

Received June 16, 2010 Accepted June 27, 2010

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Survival outcomes have been steadily improving for last 50 years in patients with colorectal cancer. The 5-fluorouracil (5-FU) is still one of the major chemotherapeutic agents. New cytotoxic agents, irinotecan and oxaliplatin, or targeted agents, bevacizumab and cetuximab, have been studied in the treatment of colon cancer. Adjuvant chemotherapy is indicated in patients with colon cancer at high-risk stage II and III, and after complete resection. Oxaliplatin-based regimens, FOLFOX, are considered as the standard adjuvant chemotherapy. If there are contraindications for oxaliplatin, the best alternatives are capecitabine or 5FU/LV. In rectal cancer, adjuvant chemotheradiotherapy is indicated in patients who had curative resection with stage II and III cancer. Adjuvant chemotherapy is necessary after neoadjuvant chemoradiotherapy in rectal cancer. The introduction of novel agents targeted to specific molecular features of cancer cells promises more options and marked improvements in efficacy for treatment of metastatic colon cancer. Bevacizumab has been shown to extend survival in colorectal cancer when used in combination with irinotecan and 5-fluorouracil-based chemotherapy, and the addition of cetuximab to irinotecan and 5-fluorouracil-based chemotherapy eliminates irinotecan resistance. Interestingly, there has been no clear association between the expression of epidermal growth factor receptor (EGFR) and response to the EGFR inhibitors. Instead, KRAS mutation has been accepted as a negative predictive factor for the treatment of cetuximab. In contrast, no valid biomarkers for bevacizimab were found so far. More studies are necessary to identify biomarkers of targeted agents. Recent advancement of chemotherapeutic agents extended survival in colorectal cancer.

Colorectal cancer; Chemotherapy; Targeted agents

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Figure 1

Recent improvement of overall survival in patients with metastatic colorectal cancer.

Table 1

Survival outcomes in patients with stage II and III colon cancer (MOSAIC trial)[13]

^*DFS: disease-free survival, OS: overall survival, HR: hazard ratio

^†FOLFOX did not result in survival benefit in patients with high-risk stage II colon cancers (T4 lesion, perforated, obstructive, poorly differentiated grade of tumor, positive venous invasion, harvested less than 10 lymph nodes during surgery).