General principles of chemotherapy

Over the last 50 years, medical treatment of solid cancers gained major advances in terms of effectiveness through breakthrough knowledge of cancer biology, technology development and identification of fundamental active drugs.

We conventionally discriminate between medical treatment of the advanced or metastatic disease and of the early disease, namely adjuvant and neoadjuvant or primary treatment, if administered after or before surgery. New drugs or treatment associations can be sequentially introduced in medical treatment of cancer patients in phase I, II and III clinical trials. No drug or drug association can be proposed in the adjuvant or neoadjuvant setting of treatment without proven effectiveness in the advanced disease. Primary endpoints of medical treatment according to the phase of the disease are safety, activity and efficacy. Different options of medical treatment may be selected for each tumor according to the specific phase of disease. In some metastatic cancers, such as colorectal cancer, the activity of medical treatment justified the development of strategies integrating also surgical resection of metastases, specifically liver, with the objective to increase efficacy.

Open question in first and subsequent lines of treatment in advanced cancer patients, particularly in MCRC patients, is the proper individualization of medical treatment according to prognostic and predictive bio-markers.