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It remains difficult to decipher which patients are appropriate candidates for conversion therapy vs upfront surgery. Therefore, in predicting potential outcomes, several factors should be considered. Here, we will attempt to address such factors and provide insights.
Due to advances in chemotherapy, biologic therapy, and the development of liver-oriented treatment options, the survival of patients with metastatic cancer has more than doubled, and increasing numbers of patients have been cured, even among those with advanced disease.
Advances in the treatment of
metastatic colorectal cancer in
the past several years have
been expeditious and exciting—even
chaotic—but with the median survival
doubled since the use of single-agent
fluoropyrimidines alone. However, new
questions continue to arise, directly affecting
our daily practice in the care of
patients with colorectal cancer. One of
these issues, the optimal therapy for
metastatic colorectal cancer, is wonderfully
explored by Dr. Saltz in this
issue of ONCOLOGY. To understand
this issue better, we may have to approach
the question a little differently:
That is, is it possible to standardize
treatment options for metastatic colorectal
cancer?
Advances in the treatment of
metastatic colorectal cancer in
the past several years have
been expeditious and exciting—even
chaotic—but with the median survival
doubled since the use of single-agent
fluoropyrimidines alone. However, new
questions continue to arise, directly affecting
our daily practice in the care of
patients with colorectal cancer. One of
these issues, the optimal therapy for
metastatic colorectal cancer, is wonderfully
explored by Dr. Saltz in this
issue of ONCOLOGY. To understand
this issue better, we may have to approach
the question a little differently:
That is, is it possible to standardize
treatment options for metastatic colorectal
cancer?
From the results of recent studies, it is likely that multimodality
therapy with chemotherapy and radiation treatment may improve the
overall outcome of locally advanced upper gastrointestinal (GI) malignancies,
including esophageal, gastric, pancreatic, and biliary tract carcinomas.
However, more effective, more optimal, and less toxic chemotherapy
regimen(s) with concomitant radiotherapy are needed beyond
the concurrent continuous-infusion fluorouracil (5-FU) with radiation
that is commonly applied in general practice. Epirubicin (Ellence),
cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy
agents in upper GI cancers. Two phase I studies were designed
to test the tolerability of the combination of radiotherapy with infusional
5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and
epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
From the results of recent studies, it is likely that multimodality therapy with chemotherapy and radiation treatment may improve the overall outcome of locally advanced upper gastrointestinal (GI) malignancies, including esophageal, gastric, pancreatic, and biliary tract carcinomas. However, more effective, more optimal, and less toxic chemotherapy regimen(s) with concomitant radiotherapy are needed beyond the concurrent continuous-infusion fluorouracil (5-FU) with radiation that is commonly applied in general practice. Epirubicin (Ellence), cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy agents in upper GI cancers. Two phase I studies were designed to test the tolerability of the combination of radiotherapy with infusional 5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
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