Perspectives and controversies in the treatment of advanced colorectal cancer--from palliation to cure.

Abstract

Advanced colorectal cancer (ACRC) has been traditionally considered resistant to chemotherapy, with no clear benefit in relation to time to progression and overall survival. Nevertheless, nowadays first and second line therapeutic approaches have dramatically changed the natural history of ACRC, and that means that at present the most important decision in a patient is not to treat or no to treat with chemotherapy, but to choose the best chemotherapy schedule at any time. Following this purpose it has been necessary, not only the emergence of new drugs and schedules, but also the understanding of the clinical efficacy. Actually, to the classic parameters such as, objective response, time to progression, and overall survival, new parameters studying clinical benefit have been added. Among these new parameters we can find the weight loss, symptom-free period, quality of life, pain-free interval, etc. Therefore, the really important aim in these situations is the patient clinical status, being less important the survival or the tumor burden reduction.