Current status and perspectives of biologics in the treatment of metastatic colorectal cancer

: Since the mid 1990s, colorectal cancer treatment has undergone substantial changes and improvements. Combination chemotherapy in first-line treatment of metastatic colorectal disease is the standard of care. Regimens based on either irinotecan or oxaliplatin given with 5-fluorouracil are prevailing. Recently, bevacizumab has become the routine standard addition to FOLFOX in first-line regimens in Japan. This preference is based on the data from NO16966 study, which resulted in a far less substantial improvement in progression free survival and no benefit in response rate. Other clinical trials indicated that the addition of the anti-EGFR monoclonal antibody confers modest benefit to FOLFOX or FOLFIRI. At present, how to combine the available agents and what the ideal combinations should be remain unclear.