A systematic review of treatment guidelines for metastatic colorectal cancer

Abstract

AimA systematic review of treatment guidelines for metastatic colorectal cancer (mCRC) was performed to assess recommendations for monoclonal antibody therapy in these guidelines.MethodRelevant papers were identified through electronic searches of MEDLINE, MEDLINE In Process, EMBASE and the Cochrane Library; through manual searches of reference lists; and by searching the Internet.ResultsA total of 57 relevant guidelines were identified, 32 through electronic database searches and 25 through the website searches. The majority of guidelines were published between 2004 and 2010. The country publishing the most guidelines was the USA (12), followed by the UK (10), Canada (eight), France (eight), Germany (three), Australia (two), Spain (two) and Italy (one). In addition, eight European and three international guidelines were identified. As monoclonal antibody therapy for mCRC was not introduced until 2004, no firm recommendations for monoclonal antibody therapy were made in guidelines published between 2004 and 2006. Recommendations for monoclonal antibody therapy first appeared in 2007 and evolved as more data became available. The most recent international, European and US guidelines recommend combination chemotherapy with the addition of a monoclonal antibody for the first-line treatment of mCRC. Second-line treatment depends on the first-line regimen used. For chemoresistant mCRC, cetuximab or panitumumab are recommended as monotherapy in patients with wild-type KRAS tumours.ConclusionThe study indicates that recent treatment guidelines have recognized the role of monoclonal antibodies in the management of mCRC, and that treatment guidelines should be updated in a timely manner to reflect the most recently available data.

CD38+ M-MDSC expansion characterizes a subset of advanced colorectal cancer patients

“…There is nascent evidence (14,15) supporting expansion of MDSC-like cells in patients with advanced-stage CRC, yet these reports do not provide enough information regarding the nature of the cells, nor do they indicate any options for targeted therapy. Currently, adjuvant therapy remains to be established in stage II CRC; adjuvant therapy is approved for stage III CRC, and therapy for stage IV CRC is complex, involving chemotherapy or targeted agents or immunotherapy (16).…”

Inhibition of C-terminal binding protein attenuates transcription factor 4 signaling to selectively target colon cancer stem cells

“…1,2 The outcomes for advanced colorectal cancer remain poor, mainly due to disease relapse. 3 The survival of a smaller population of CSCs with the ability to self-renew, resulting in reconstitution of the entire tumor, is at the heart of such relapses. 1 Hence, a therapeutic paradigm aimed at selectively targeting CSCs is gaining momentum as a singular approach to achieve long-term disease control or cure.…”

Neoadjuvant therapy of bevacizumab in combination with oxaliplatin and capecitabine (XELOX) for patients with metastatic colorectal cancer with unresectable liver metastases: a phase II, open‐label, single‐arm, noncomparative trial

“…19,20 Monoclonal antibodies are recommended by many international guidelines for the management of mCRC. 21 Bevacizumab (Avastin; F. HoffmannLa Roche Ltd., Genentech, Inc., San Francisco, CA, USA) is one such humanized recombinant monoclonal antibody that binds to and blocks the activity of all isoforms of vascular endothelial growth factor-A (VEGF-A). 22,23 Studies show that bevacizumab in combination with commonly used chemotherapeutic agents demonstrates a higher response rate (RR), progression-free survival (PFS) and overall survival (OS) versus chemotherapy alone in patients with mCRC, 22,[24][25][26] along with an acceptable safety profile in patients with unresectable mCRC.…”