Metastatic colorectal cancer: Current treatment and future options for improved survival Medical approach - present status
Metastatic colorectal cancer: Current treatment and future options for improved survival Medical approach - present status
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DOI：
10.3109/00365521.2012.640828
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发表时间：
2012-03-01
影响因子：
1.9
通讯作者：
Cavalli-Bjorkman, Nina
中科院分区：
文献类型：
--
作者：
Glimelius, Bengt;Cavalli-Bjorkman, Nina
背景转移性结直肠癌预后差，大多数患者只能采取姑息措施。使用药物治疗的发展进行了审查。材料和方法。一个系统的方法，以文献为基础的证据，从姑息化疗和靶向药物的影响，旨在。结果在过去的20-25年中，一些大型结论性试验记录了持续的改善。在20世纪80年代末，应该使用化疗的证据非常有限，而目前大多数患者可以根据良好的科学证据提供三线化疗，有或没有靶向药物。在最近的试验中，试验中的中位生存期已从约6个月逐渐改善至24个月以上。然而，人口的生存率没有得到同样程度的改善。一些重要的问题仍有待解决，如最佳治疗顺序，在各种情况下使用什么方案，何时开始以及何时停止，如果看到反应，是否可以治愈一小部分患者，以及社会经济问题。手术和其他局部方法的结合进一步改善了某些患者的预后，但必须进行微调。结论.晚期结直肠癌进展迅速。这可能是学术界和工业界合作设计良好的试验的结果，显示出对这种疾病的极大兴趣。多专业的方法和未来的合作可能会引入新的治疗概念，进一步改善结果。
Background. Metastatic colorectal cancer has a poor prognosis, and the majority of patients are left with palliative measures. The development seen using medical treatments are reviewed. Material and methods. A systematic approach to the literature-based evidence of effects from palliative chemotherapy and targeted drugs was aimed at. Results. The continuous improvements during the past 20-25 years have been documented in several large conclusive trials. At the end of the 1980s, the evidence that chemotherapy should be used at all was very limited, whereas presently most patients can be offered three lines of chemotherapy with or without a targeted drug based upon good scientific evidence. Median survival in trials has gradually improved from about 6 months to above 24 months in the most recent trials. Survival in the populations has, however, not improved to the same extent. Several important issues remain to be solved, such as the best sequence of treatments, what regimens to use in various situations, when to start and when to stop if a response is seen, whether cure may be possible in a small subset of patients, and socioeconomic issues. Integration of surgery and other local methods have further improved outcome for some individuals, but must be fine-tuned. Conclusions. Progress has been rapid in advanced colorectal cancer. This is likely a result of well-designed trials in collaboration between academy and industry, showing a great interest in the disease. A multi-professional approach and future collaborations may hopefully introduce new treatment concepts, further improving outcome.