Sequential or combination chemotherapy for a patient with mCRC?

SummaryA 62-year-old male presents with colon cancer that has metastasized to both lobes of the liver. Resection was performed; chemotherapy initially consisted of combination treatment with FOLFIRI or XELIRI plus bevacizumab, with the possibility of changing treatment to either FU/LV or capecitabine, combined with bevacizumab. Although reported data would allow the consideration of a strategy of sequential treatment in this patient, the consulting oncologists treating him have acknowledged the benefit of a strategy employing “inductive” combination chemotherapy plus monoclonal antibodies. Combination chemotherapy offers the potential for longer treatment holidays than is possible with sequential therapy. One of the enduring concepts informing treatment decisions for mCRC is that patients who receive the three mainstays of drug treatment fluorouracil, irinotecan, and oxaliplatin fare better than those who do not.