Importance of the field: Treatment options for metastatic colorectal cancer (mCRC) patients have rapidly increased in the past years, but 50 - 70% of mCRC patients are still unlikely to undergo radical resection of metastases and are candidates for palliative therapy only.
Areas covered in this review: Oxaliplatin and irinotecan have widened the chemotherapy alternatives available in this setting and effective targeted agents against vascular endothelial growth factor and epidermal growth factor receptor have further improved treatment efficacy. This review covers the main areas of debate in the optimal treatment of unresectable mCRC patients, focusing on the implications for everyday clinical practice and future research of the most relevant clinical trials and molecular investigations published from 1999 to 2009.
What the reader will gain: Insights into treatment individualization strategies are provided in the review.
Take home message: 'One size fits all' can not longer be considered an adequate approach to unresectable mCRC, and treatment with both chemotherapy and biologic agents should be guided by prognostic and predictive factors in order to maximize the benefit while reducing futile toxicities.