A perspective on the current management of advanced colorectal cancer

Although the median survival of patients with advanced disease has progressively increased, colorectal cancer remains a major worldwide health problem, with approximately 1 million new cases and 500,000 deaths every year. At the 2013 World Congress on Gastrointestinal Cancers, investigators have recently dealt with many clinically relevant questions, such as the preferred biologic drug to be used upfront in patients with KRAS wild-type colorectal tumors, the optimal treatment intensity, the most suitable maintenance strategy, the need for deeper molecular information when using EGFR inhibitors and the use of antiangiogenic drugs in the elderly. Briefly summarizing all the news coming from this moving landscape, this article focuses on the results of the major randomized Phase III trials presented at the meeting.

Bevacizumab in colorectal cancer: current and future directions

Bevacizumab is a humanized monoclonal antibody to VEGF-A, an important therapeutic target through its proangiogenic effects on a variety of tumors. Bevacizumab has demonstrated clinically meaningful benefit in conjunction with chemotherapy for patients with metastatic colorectal cancer as well as other tumor types. Bevacizumab is a well-tolerated therapy with regard to toxicity, in keeping with its biological vascular effect. In this era of personalized medicine, current Phase II and III trials are further defining its role at various stages of metastatic disease and the optimal sequencing with cytotoxic and other targeted agents to achieve further improvements in patient outcome. Translational research for biomarker discovery and validation and further study into mechanisms of resistance are essential for future development and sustained benefit with this class of therapeutic agents.

Bevacizumab-based therapies in the first-line treatment of metastatic colorectal cancer

Since its approval for the first-line treatment of metastatic colorectal cancer (mCRC), bevacizumab has become a standard treatment option in combination with chemotherapy for patients with mCRC. Bevacizumab has demonstrated efficacy in combination with a number of different backbone chemotherapy regimens, and its widespread use has introduced several important questions regarding the selection and optimization of bevacizumab-based treatment regimens, its use in various patient populations, and the identification of associated adverse events. This review discusses the results of several phase II and phase III clinical trials, as well as large observational studies, to address the use of bevacizumab in the treatment of patients with mCRC in the first-line setting.

XELOX in colorectal cancer: a convenient option for the future?

XELOX is a 3-weekly chemotherapy combination of oral capecitabine and intravenous oxaliplatin. The central hypothesis that led to its development was that it would provide a convenient and cost-effective alternative to intravenous fluorouracil-based chemotherapy doublets, without compromising on anti-tumor efficacy. Recently its role in colorectal cancer has become more established in both the metastatic and adjuvant setting. Ongoing investigation of XELOX continues in a number of directions: its combination with novel biological agents, its efficacy and safety in the elderly, and the development of biomarkers that can predict its anti-tumor effect. This article provides a comprehensive and up-to-date synopsis of all pertinent clinical studies detailing this regimen and its promise for the future.

Maintenance therapy in colon cancer

In the last decade dramatic improvements have been obtained in the treatment of metastatic colorectal cancer. Thanks to the introduction in the clinical practice of new drugs such as Irinotecan and Oxaliplatin, and modern biological drugs such as Bevacizumab and Cetuximab, the response rate, progression-free and overall survival are about 50-60%, 9-11 and 20-24 months respectively. Despite this progress, many questions remain unsolved especially those related to the optimal duration of treatment and the role of maintenance therapy. To treat until progression (or unacceptable toxicity) is the classical way but in the common clinical practice is frequent to perform an induction therapy (until the maximum response is obtained) followed by a complete stop and restart on progression, or by a maintenance without the drug/s responsible of the major cumulative toxicities. The following report focus on the role of different strategies respect to the classic "treatment until progression".

Current status of molecularly targeted therapy for hepatocellular carcinoma: clinical practice

In recent years, molecular-targeted agents have been used clinically to treat various malignant tumors. In May 2009, sorafenib (Nexavar) was approved in Japan for "unresectable hepatocellular carcinoma (HCC)", and was the first molecular-targeted agent for use in liver cancer. To date, sorafenib is the only molecular-targeted agent whose survival benefit has been demonstrated in two global phase III randomized controlled trials, and it has now been approved worldwide. Phase III clinical trials are now underway to compare other molecular-targeted agents with sorafenib as first-line treatment agents, and to evaluate other multi-kinase inhibitors of the vascular endothelial growth factor and platelet-derived growth factor receptors, as well as drugs targeting the epidermal growth factor receptor, insulin-like growth factor receptor, and mammalian target of rapamycin, in addition to other molecules targeting other components of the signal transduction pathways. This review outlines the main pathways involved in the development and progression of HCC and the agents that target these pathways.