Progress in Colorectal Cancer

Isabella Martire, M.D.

from "Your Health Magazine,"September 2010

      I remember the days when the only treatment for colorectal cancer was 5-fluorouracil and leucovorin--and it was not that long ago. On the average, a patient with stage IV disease had between one and two years survival.

     Then, the “new” chemotherapeutic agents started appearing. Irinotecan was FDA approved, in 2000.  Both Oxaliplatin 4, and Xeloda were approved, in 2004. The beauty of Xeloda is that it is an oral fluoropirimidine, which means that it can substitute for continuous infusion 5fu; making patient’s life a lot easier.  Oxaliplatin and Xeloda are now part of adjuvant regimens for duke c colon cancer which confer a 38% improvement in survival.

     What has been really exciting is the increasing knowledge of the biology of colorectal cancer and the discovery that certain receptors and growth factors that are over-expressed contributing to the cancer growth that could now be used as the therapeutic targets. The overexpression of the EGFR (epidermal growth factor receptor) lead to the development of monoclonal antibodies that inhibit the receptor downregulating tumor cell growth. Erbitux was FDA approved, in 2004, and Vectibix, in 2006, for metastatic colorectal cancer.

      It is also well known that tumors, in order to grow and metastasize, need an increased vascular supply and that in order to do so,  they over-express VEGF (vascular endothelial growth factor). VEGF has therefore become the target of new classes of agents called antiangiogenic therapies.  Avastin was FDA approved for stage IV colorectal cancer, in 2004. Therefore, we are able to battle this disease with a variety of options including chemotherapy, monoclonal antibodies, and antiangiogenic treatments. This means that stage IV colorectal cancer patients live a lot longer than they used to and have the option of having therapeutic regimens that do not include chemotherapy agents; avoiding nausea, vomiting and hair loss.

     We still have a long way to go;  but we've come a long way, over the last 10 years.