Systemic therapy for metastatic colorectal cancer

In the treatment of advanced colorectal cancer (CRC), the addition of so-called "targeted" agents to irinotecan- and oxaliplatin-based regimens has resulted in statistically significant--but often clinically modest--improvements in progression-free and overall survival. This is true for the most recent additions to the treatment armamentarium, regorafenib and ziv-aflibercept. In his recent presentation at the NCCN 18th Annual Conference, Leonard Saltz, MD, reviewed the landmark trials establishing targeted agents as effective in metastatic CRC. However, he also noted that statistical significance does not necessarily equal clinical significance, and indicated that clinicians should consider the differential toxicity profiles of the regimens when individualizing treatment.