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Abstract
Colorectal cancer (CRC) is a worldwide public health problem, with nearly 800,000
new cases diagnosed each year, resulting in approximately 500,000 deaths. When advanced
metastatic disease is diagnosed, CRC is associated with a poor prognosis, and 5-year
survival rates are in the range of 5%-8%. Chemotherapy has been the mainstay approach
for patients with advanced CRC. For nearly 40 years, the main drug used for this disease
was the fluoropyrimidine 5-fluorouracil (5-FU). Significant advances have been made
in chemotherapy treatment options for patients with metastatic disease, such that
improvements in 2-year survival are now being reported with median survival rates
of 21 months to 24 months. Over the past 10 years, 3 new cytotoxic chemotherapy agents
have been approved by the FDA for metastatic CRC. These compounds include the topoisomerase
I inhibitor irinotecan, the third-generation platinum analogue oxaliplatin, and the
oral fluoropyrimidine capecitabine. Since 2004, 3 novel biologic agents have been
approved by the FDA, and they include the anti–epidermal growth factor receptor antibodies
cetuximab and panitumumab and the anti–vascular endothelial growth factor bevacizumab.
The oral fluoropyrimidine capecitabine has been effectively and safely combined with
irinotecan (CAPIRI) and/or oxaliplatin (CAPOX). Three randomized phase III studies
have now shown that CAPOX is equivalent to FOLFOX (5-FU/leucovorin/oxaliplatin)–based
regimens. Significant interest has centered around combining capecitabine-based cytotoxic
regimens with the biologic agents, and specifically, bevacizumab and cetuximab. This
review will update the current status of these capecitabine-based combination regimens.
Key words
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Article info
Publication history
Accepted:
November 2,
2007
Received in revised form:
October 26,
2007
Received:
September 18,
2007
Footnotes
This article includes discussion of investigational and/or unlabeled uses of drugs, including the use of cetuximab as first-line treatment for metastatic colorectal cancer.
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
