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Sequencing of Systemic Chemotherapy for Unresectable CRLM

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Colorectal Cancer Liver Metastases

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Abstract

Nearly half of all patients diagnosed with colorectal cancer will develop liver metastases during the course of their disease, and only a minority of these will undergo resection, making systemic treatment options for metastatic disease a vital component of the treatment algorithm. Options for treating metastatic colorectal cancer have expanded tremendously with the addition of antibody therapy and small molecule inhibitors to traditional cytotoxic treatment. But with so many available agents, choosing suitable first-line and subsequent regimens can be overwhelming. Many factors play role in this decision, including medical comorbidities and their implications on performance status (PS), prior treatment, goals of therapy (i.e., quality of life, resection, etc.), and, importantly, patient preference. This chapter will describe the options for systemic treatment of metastatic colorectal cancer that is unlikely to downstage to resection and the data behind them. A historic framework will be provided for basic concepts, but focus will be placed on recently published trials and inclusion of updated guideline recommendations.

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Notes

  1. 1.

    Other combinations were investigated (IROX, IFL), but are not as commonly used as first line and therefore will not be covered in this chapter. Of note, capecitabine combinations with irinotecan have led to excessive toxicity and are not recommended.

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  1. Vanderbilt University Medical Center, Nashville, TN, USA

    Marc T. Roth & Laura W. Goff

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  2. Banner MD Anderson Cancer Center, Phoenix, AZ, USA

    Michael A. Choti

  3. Virginia Mason Medical Center, Seattle, WA, USA

    Flavio G. Rocha

  4. Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Ageo Shi, Saitama, Japan

    Go Wakabayashi

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Roth, M.T., Goff, L.W. (2020). Sequencing of Systemic Chemotherapy for Unresectable CRLM. In: Correia, M., Choti, M., Rocha, F., Wakabayashi, G. (eds) Colorectal Cancer Liver Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-25486-5_23

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