- Volume 7
- Issue 1 Publication Date: January 2008
Second-Line Management of Metastatic Colorectal Cancer
David J. Gallagher, Nancy Kemeny
The treatment of colorectal cancer has increased in complexity in recent years, with patients now receiving many lines of treatment. Standard first-line therapy has evolved with biologic agents used frequently in first-line settings. However, data are lacking to guide treatment decisions upon progression. Now that more is known about the toxicities of commonly used agents, such as irinotecan and oxaliplatin, stop-and-go strategies have been explored to decrease toxicities. The importance of resecting disease and decreasing tumor burden is recognized and there is some ability to get to resection even after second-line therapy. Local therapies, such as hepatic arterial infusion chemotherapy, have allowed a select group of patients to be approached with curative intent. This article reviews treatment options after progression on irinotecan- or oxaliplatin-based first-line therapy and highlights some of the difficulties encountered when interpreting data.