Second-line management of metastatic colorectal cancer

The treatment of colorectal cancer has increased in complexity in recent years, with patients now receiving many lines of treatment. Standard first-line therapy has evolved with biologic agents used frequently in first-line settings. However, data are lacking to guide treatment decisions upon progression. Now that more is known about the toxicities of commonly used agents, such as irinotecan and oxaliplatin, stop-and-go strategies have been explored to decrease toxicities. The importance of resecting disease and decreasing tumor burden is recognized and there is some ability to get to resection even after second-line therapy. Local therapies, such as hepatic arterial infusion chemotherapy, have allowed a select group of patients to be approached with curative intent. This article reviews treatment options after progression on irinotecan- or oxaliplatin-based first-line therapy and highlights some of the difficulties encountered when interpreting data.