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Gastrointestinal Cancer

The Continuum of Care: A Paradigm for the Management of Metastatic Colorectal Cancer

^a Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; ^b Division of Hematology/Medical Oncology, Vanderbilt University, Nashville, Tennessee, USA; ^c Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; ^d Division of Hematology/Oncology, Northwestern University, Chicago, Illinois, USA; ^e Oregon Health & Science University Cancer Institute, Portland, Oregon, USA; ^f Division of Hematology/Oncology, University of Alabama School of Medicine, Birmingham, Alabama, USA; ^g Division of Medical Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; ^h Division of Medical Oncology, University of Southern California, Los Angeles, California, USA; ⁱ Divisions of Medical Science and Population Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA; ^j Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA; ^k Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; ^l Department of Adult Health Nursing, Rush University Medical Center, Chicago, Illinois, USA; ^m University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; ⁿ Department of Nursing at University of California San Francisco Medical Center, San Francisco, California, USA

Key Words. Colorectal cancer • Chemotherapy • Biologic therapy

Correspondence: Mace L. Rothenberg, M.D., 777 Preston Building, Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-6307, USA. Telephone: 615-936-1796; Fax: 615-343-7602; e-mail: mace.rothenberg{at}vanderbilt.edu

New agents for the treatment of metastatic colorectal cancer have extended median overall survival to more than 20 months, an increase that has changed the view of advanced colorectal cancer from an acute to a chronic condition. This article proposes a shift in treatment strategy from the concept of successive "lines" of therapy, in which chemotherapy is continued until disease progression, to that of a continuum of care, in which the use of chemotherapy is tailored to the clinical setting and includes switching chemotherapy prior to disease progression, maintenance therapy, drug "holidays," and surgical resection of metastases in selected patients. In this approach, the distinction between lines of therapy is no longer absolute. This represents a paradigm shift in the management of metastatic colorectal cancer to that of a continuum of care approach that includes individualized planning, in which patients are given the opportunity to benefit from exposure to all active agents and modalities while minimizing unnecessary treatment and toxicity, with the ultimate goal of improving survival as well as quality of life.

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