Emerging
Challenges and Opportunities for the Treatment of Hepatic
Metastases Derived from Colorectal Cancer Primaries
Published in the Fall of 1998Summary
Optimism
is now flourishing that within the next decade, there will be significant
advances made in the overall diagnosis and therapy of cancers of all
types, including colorectal cancers. Therapy for patients with advanced
disease, including colorectal cancer patients with metastases to the
liver, is being viewed with increasing optimism. Colorectal cancer
therapy of the recent past has relied on early diagnosis, surgery,
radiation and chemotherapy using standard agents such as fluorinated
pyrimidines. Recently completed clinical studies may indicate a role
for agents such as leucovorin, and for Camptosar used in combination
with fluorauracil and leucovorin. Similar combination approaches with
newly emerging chemotherapeutic agents such as Tomudex may improve
the overall survival rate of colorectal patients even further. With
continued advances in surgical techniques for hepatic resection, and
earlier detection of hepatic metastases through improved diagnoses,
the number of suitable candidates for hepatic resection should rise.
Survival for patients undergoing hepatic resection most likely will
continue to improve as the new chemotherapeutic regimens are used
post-operatively. Gradually the chemotherapeutic armamentarium will
be replaced with other types of pharmacological agents derived, for
example, from signal transduction, gene therapy, immunology, or an
understanding of angiogenesis. More patients will move from palliation
to true therapy with the possibility for cure or control of their
cancer leading to significant growth in the overall market for therapeutic
agents for colorectal cancer and associated metastases.