Abstract
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.
© 2015 by American Society of Clinical Oncology.
MeSH terms
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Angiogenesis Inhibitors / adverse effects
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Angiogenesis Inhibitors / therapeutic use*
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Biomarkers, Tumor / genetics
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Colorectal Neoplasms / drug therapy*
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Colorectal Neoplasms / genetics
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Colorectal Neoplasms / mortality
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Colorectal Neoplasms / pathology
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Drug Resistance, Neoplasm
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Genetic Testing
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Humans
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Molecular Targeted Therapy* / adverse effects
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Molecular Targeted Therapy* / mortality
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Molecular Targeted Therapy* / trends
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Mutation
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Neoplasm Metastasis
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Patient Selection
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Precision Medicine
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Predictive Value of Tests
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Protein Kinase Inhibitors / adverse effects
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Protein Kinase Inhibitors / therapeutic use*
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Proto-Oncogene Proteins / genetics
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Proto-Oncogene Proteins B-raf / genetics
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Proto-Oncogene Proteins p21(ras)
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Risk Factors
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Time Factors
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Treatment Outcome
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ras Proteins / genetics
Substances
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Angiogenesis Inhibitors
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Biomarkers, Tumor
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KRAS protein, human
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Protein Kinase Inhibitors
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Proto-Oncogene Proteins
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BRAF protein, human
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Proto-Oncogene Proteins B-raf
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Proto-Oncogene Proteins p21(ras)
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ras Proteins