Hôpital privé Jean Mermoz, service d’oncologie digestive, 55 avenue Mermoz, 69008 Lyon, France
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.