Colorectal Cancer Treatment: What's Next? (or: Is There Life After EGFR and VEGF?).

In the past 10 to 15 years, the number of approved agents for treatment of colorectal cancer has expanded from only one (in 1995) to seven (as of 2006), with the most recent additions being the targeted agents cetuximab, bevacizumab, and panitumumab. While real progress has been made, these advances have translated into more modest improvements in patient outcomes than had been anticipated. Better understanding of the molecular underpinnings of colorectal cancer and of each patient's genetic makeup will likely improve the selection of treatment for each individual, leading to reduced toxicity and cost in patients spared therapy because they are unlikely to respond, and higher benefit in the subset of patients harboring the target of interest. KRAS mutational status was recently identified as an important marker for response to EGFR-directed therapies, and other pathways being explored include the immune system (anti-cytotoxic T lymphocyte antigen 4 [anti-CTLA4] monoclonal antibodies), insulin-like growth factor 1 receptor (IGF1R) (IGF1R monoclonal antibodies), the mammalian target of rapamycin (mTOR) (mTOR kinase inhibitors), and others. Results of trials evaluating agents targeting these pathways are awaited. New paradigms and treatments are needed to advance the landscape for patients with advanced and metastatic colorectal cancer.