Optimizing first-line chemotherapy for metastatic colorectal cancer

Up to half of all patients who develop colorectal cancer will be treated for metastatic disease; some can be cured but most are simply palliated. The optimum use of the available drugs tailored to the patient should be informed by evidence, where it is available, and are of much current debate. Treatment objectives must be clear in making these decisions. Improved response rate may be appropriate where disease may become resectable, with an aim for cure. Tolerability and quality of life balanced with long-term survival may be most relevant where this is not feasible. A good start appropriate to the individual in the first-line metastatic setting is of both physical and psychological importance and may affect subsequent therapeutic decisions. Where Phase III randomized controlled trial evidence is missing, clinical decisions must still be made. Here we explore the data available for optimized first-line therapy, the options created from this data and balance this against the benefits to the patient as a whole.