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Abstract
The medical treatment of colorectal cancer (CRC) has evolved greatly in the last 10 years, involving complex combined chemotherapy protocols and, in more recent times, new biologic agents. Advances in adjuvant therapy have been limited to the addition of oxaliplatin and the substitution of oral fluoropyrimidine (e.g., capecitabine) for intravenous 5-fluorouracil with no evidence for improved outcome with biological agents. Clinical benefit from the use of the targeted monoclonal antibodies, bevacizumab, cetuximab and panitumumab, in the treatment of metastatic CRC is now well established, but the optimal timing of their use requires careful consideration to derive the maximal benefit. Evidence to date suggests potentially distinct roles for bevacizumab and EGF receptor-targeted biological agents (cetuximab and panitumumab) in the treatment of metastatic CRC. This article reviews the evidence in support of modern treatments for CRC and the decision-making behind the treatment choices, their benefits and toxicities.
Financial & competing interests disclosure
TJ Price, E Segelov, M Burge, SP Ackland, NC Tebbutt, CS Karapetis, N Pavlakis and JD Shapiro have received honoraria and travel support to attend national and international meetings for colorectal cancer from Merck Serono, AMGEN, Roche and sanofi-aventis. Disclosures for the international faculty are as follows: D Cunningham has received research funding from Roche, Amgen and MerkSerono; AF Sobrero has received consultant/honorarium from Merck Serono, Roche, sanofi-aventis, Pfizer, AstraZeneca and Bayer and DG Haller has received consultant/honoraria from sanofi-aventis, Amgen and Genentech and research funding from Roche. The group meeting that enabled the material for this review to be assembled was supported by an unrestricted educational grant from Roche provided to the ‘Adelaide Colorectal Tumour Group’ which facilitated the meeting. Roche did not participate in data compilation or in the writing or viewing the submitted review. TJ Price has had full access to all the data, warrants that all information has been reviewed and accepted by all participants and is responsible for the decision to submit this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.