演題抄録

臓器別シンポジウム

開催概要
開催回
第51回・2013年・京都
 

Advanced Colorectal Cancer: Where Are We Now and Where Are We Going?

演題番号 : OS3-1

[筆頭演者]
Joel Randolph Hecht:1 

1:David Geffen School of Medicine at UCLA, USA

 

After decades of stagnation, the treatment of advanced colorectal cancer was revolutionized by the advent of new cytotoxic and biologic agents. This lead to median survivals of more than two years in some trials and an increasing percentage of patients being able to get potentially curative metastatectomies or being alive at five years with inoperable disease. The majority of these improvements in outcome are the result of adding irinotecan and oxaliplatin to fluoropyrimidines. The use of newer anti-angiogenic and anti-EGFR antibodies further benefited patients. Despite these advances, however, there has been little change in the treatment of metastatic disease for nearly a decade with multiple negative large randomized phase III trials. After this long lull, there finally appears to be movement in the field. We are learning how to better identify patients for targeted therapies, in particular with anti-EGFR antibodies. In addition, there are new approaches that may yield clinical benefit from this older target. New anti-VEGF pathway therapies such as ziv-afilbercept and regorafenib, as well as expanded indications for approved drugs such as bevacizumab, have also improved survival. Better understanding of the biology of colorectal cancer using new technology as shown by the Cancer Genome Atlas Network holds the promise of identifying molecularly distinct subtypes and truly tailoring therapy to the patient. New agents such as inhibitors of tumor stroma and the MAPK, PI3K, and Wnt pathways as well as rational combinations of these agents are currently being studied. Finally, advances in tumor immunology and eradication of cancer stem cells may eventually yield long lasting responses in patients with metastatic disease.

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