First-line combination treatment of colorectal cancer with hepatic metastases: choosing a targeted agent.

A 56-year-old man has a history of bright red blood per rectum for 3 months; computed tomography reveals 4 hepatic lesions in the right lobe, the largest measuring 5.5 cm. Chemotherapy may accomplish sufficient reduction of the hepatic tumor burden to enable surgery with curative intent. Both FOLFOX and FOLFIRI are appropriate, highly active first- line regimens that may also be administered as second-line salvage chemotherapy. Research continues to evaluate the safety and efficacy of combining bevacizumab and cetuximab or adding them singly to established chemotherapy regimens. In patients with initially unresectable tumors, a direct relationship of response to chemotherapy with attainment of resectability supports a strategy of using the most active regimens in potentially curable patients. Literature confirms the importance of exposing patients to the most efficacious agents during the course of disease treatment. Genetic testing for specific mutations such as KRAS may be helpful for supporting a treatment decision to use cetuximab.