Future prospects for palliative care of mCRC

The last two decades have seen a transformation in the management of metastatic colorectal cancer (mCRC), as first irinotecan and later oxaliplatin, capecitabine and the three approved targeted therapies have been added to 5-fluorouracil (5-FU) as options for treatment of this tumour. These developments have brought with them a significant improvement in outlook for many patients diagnosed with mCRC, as median overall survival (OS) has increased from approximately 12 months to over 2 years. With the continued high level of interest in searching for new drugs and regimens for improving the management of mCRC, as reflected in the large number of studies undertaken, further improvements can be expected in the near future. Doublet chemotherapy is now accepted as the standard of treatment for many patients. Studies are currently investigating the benefits of using combinations of three cytotoxic agents as well as exploring the impact that the addition of one or more targeted agents to combination chemotherapy can have on improving mCRC care. Promising results have already been reported in phase III studies, although further studies are required to determine the best regimens for particular settings. In addition to considering the clinical setting, it may also be relevant to consider tailoring therapy to the individual patient, based on the presence or absence of biomarkers predictive of response to a particular therapy. There is much interest in this approach and retrospective studies have identified a number of response markers to particular regimens. Prospective studies are required to further evaluate such markers and determine their possible value in the clinic. It can be hoped that such developments will help improve the outlook of many patients diagnosed with mCRC in the future.