Optimal management of metastatic colorectal cancer: current status

Colorectal cancer remains one of the most common causes of cancer death in the US, with approximately a quarter of patients presenting with metastatic disease at the time of diagnosis. Recent advances over the past 2 decades have increased the repertoire of chemotherapeutic agents for this disease and extended median overall survival to more than 20 months. An increasing body of evidence also supports the addition of targeted agents, those directed towards vascular endothelial growth factor and epidermal growth factor receptors, to expand treatment options for patients with metastatic disease. Ongoing trials are exploring the optimal combinations of these drugs as well as promising new investigational agents that take advantage of the genetic aberrations that drive tumour biology. This review aims to summarize the pertinent data on available cytotoxic and biological agents used to extend survival in metastatic colorectal cancer patients and provide a modern approach to treatment strategies while acknowledging the areas of controversy on which future clinical trials should be based.