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The Role of Systemic Chemotherapy in Colorectal Cancer

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Abstract

In recent decades, treatment for metastatic colorectal cancer (mCRC) has remarkably progressed with the advent of biological agents. Under such circumstances, it becomes a key issue which biological agent is a preferred treatment, especially for first-line treatment of mCRC patients with RAS wild-type tumor. For unresectable diseases, preferred treatment depends on the treatment goal; patients should be treated to seek for maximum shrinkage or treatment duration. If the former, anti-EGFR mab might be a preferred option in terms of depth of response. If the latter, bevacizumab might be preferred in terms of maintenance therapy. For potentially resectable diseases, such as liver-limited diseases, a similar strategy for treatment can be recommended. There are several types of liver metastases (LM). If LM is bulky and unresectable, a tumor shrinkage is needed so that LM can be converted to be resectable. If LM is disseminated and unresectable, a pathological effect is needed to prevent recurrence after liver resection. If the former, anti-EGFR mab might be preferred, and if the latter, bevacizumab might be better, considering the characteristics of biological agents.

Postoperative adjuvant chemotherapy is performed after curative resection for colorectal cancer to prevent recurrence and improve patients’ prognosis. Because therapeutic outcomes for colorectal cancer are better in Japan than in other countries, adjuvant chemotherapy tailored to be optimal for individual patients should be introduced based on not only evidence from overseas but also the results of Japanese clinical trials. Attention is focusing on biomarkers for identifying high-risk patients who require adjuvant chemotherapy.

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  1. Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Hiroyuki Uetake, Shinichi Yamauchi & Kenichi Sugihara

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  1. Hiroyuki Uetake
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Correspondence to Hiroyuki Uetake .

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  1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Nam Kyu Kim

  2. Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

  3. Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan

    Jin-Tung Liang

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Uetake, H., Yamauchi, S., Sugihara, K. (2018). The Role of Systemic Chemotherapy in Colorectal Cancer. In: Kim, N., Sugihara, K., Liang, JT. (eds) Surgical Treatment of Colorectal Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-5143-2_30

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