John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Treatment holidays and maintenance therapy in metastatic colorectal cancer Volume 22, issue 4, Avril 2015

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Authors
Hôpital privé Jean Mermoz, service d’oncologie digestive, 55 avenue Mermoz, 69008 Lyon, France
* Tirés à part

The introduction of new chemotherapy regimens and targeted therapies has significantly prolonged survival in metastatic colorectal, which led to the need for therapeutic strategies including maintenance therapy and chemotherapy-free intervals to avoid cumulative toxicity (oxaliplatin neurotoxicity), but also physical or psychological asthenia due to prolonged chemotherapy. Several randomized controlled trials, mainly using a 5-FU/oxaliplatin-based induction chemotherapy, have evaluated these strategies and have demonstrated that a « stop and go » approach to the delivery of oxaliplatin could be a therapeutic standard that does not compromise patient survival. A maintenance therapy may be proposed after a 3 to 6 months period of aggressive induction therapy. The optimal regimen for maintenance therapy remains to be defined but a 5-FU-bevacizumab combination may be considered as a reference treatment. The role of anti-EGFR antibodies in this setting remains to be validated since no randomized phase III has evaluated them as a maintenance therapy. Treatment holidays must be reserved for very good responder patients to induction chemotherapy and should not be pre-planned. A 4 to 6 month period of induction chemotherapy is recommended before considering a complete therapeutic interruption.