Second-line chemotherapy in advanced and metastatic CRC

Area of Science:

• Oncology
• Clinical Trials
• Gastrointestinal Oncology

Background:

• Colorectal cancer (CRC) often requires second-line chemotherapy after treatment failure.
• Evaluating salvage chemotherapy is crucial for improving patient outcomes in advanced CRC.

Purpose of the Study:

• To assess the efficacy of second-line chemotherapy in advanced colorectal cancer.
• To synthesize evidence from randomized controlled trials (RCTs) on salvage chemotherapy for CRC.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, and The Cochrane Library up to September 2007.
• Inclusion of RCTs evaluating second-line chemotherapy in advanced CRC patients with disease progression.
• Descriptive analysis due to clinical heterogeneity of included studies.

Main Results:

• Seven RCTs were included; one high-quality, five moderate-quality.
• Second-line irinotecan showed moderate improvements in overall and progression-free survival versus Best Supportive Care (BSC) and fluorouracil (5-FU).
• Fractionated administration of irinotecan was not superior and increased toxicity; oxaliplatin data are pending.

Conclusions:

• Second-line chemotherapy effectively prolongs progression time and survival in advanced CRC.
• Further RCTs are required to establish optimal second-line chemotherapy regimens for CRC.