ABSTRACT
Untreated patients with metastastic colorectal cancer (CRC) have a median survival of five to six months. The use of more optimal infusional 5-fluorouracil (FU)/folinic acid (FA) regimens has changed the attitude towards the treatment of patients with advanced CRC. Animal models suggest additive efficacy and sometimes synergy can be achieved using epidermal growth factor receptor inhibitors in combination with agents that inhibit the vascular endothelial growth factor receptor. The association between rash severity and survival seems to hold true across the range of clinical trials of cetuximab in CRC, and indeed in the treatment of tumors at other disease sites. The median survival of the combination treatment was not significantly prolonged, probably because of the effect of crossover in the patients treated with 5-FU/FA alone and also because the trials were not powered to show a survival difference. Raltitrexed, irinotecan, and oxaliplatin have been developed and extensively studied in the first-line treatment of metastatic.
