INTRODUCTION

Recent estimates for cancer incidence and mortality in Europe continue to rank colorectal cancer as the second most common cause for cancer related death. Every year more than 376 000 patients are newly diagnosed with colorectal cancer and approximately 200 000 people die from the disease.¹ Even though these numbers show a slight decrease,^2,3 partially due to more effective screening programmes, they still represent a major medical and economic challenge. During the past 10 years, intensive clinical studies helped to establish the value of adjuvant therapy for colorectal cancer. The introduction of new chemotherapeutic agents such as irinotecan and oxaliplatin has led to a significant increase in tumour response and median survival. In advanced colorectal cancer, impressive prolongation of overall survival can be achieved through sequential application of combined systemic chemotherapy. In addition, targeted manipulation of molecular tumour mechanisms with new substances such as monoclonal antibodies against the epidermal growth factor receptor or vascular endothelial growth factor shows promising effects. Apart from the encouraging improvement in treatment results, introduction of new drugs and strategies has multiplied the available treatment options, which are much more complex and sometimes confusing in their variety.

This review aims to summarise the current systemic treatment options of colorectal cancer with an additional focus on new classes of targeted compounds recently introduced into clinical management.

TREATMENT STRATEGIES

The only curative strategy in the treatment of colorectal cancer is, and so far remains, complete surgical resection. Despite the fact that approximately 70–80% of patients are eligible for curative surgical resection at the time of diagnosis,^4,5 five year overall survival is only 50–60%.^6–8 Two out of three patients who undergo curative resection will experience local recurrence or distant metastases. In 85%, relapse is diagnosed within the first 2.5 years after surgery.⁹ This …