The median duration of survival in patients with metastatic colorectal cancer (mCRC) is now around 30 months, largely owing to the use of sequential lines of chemotherapy combined with targeted agents including anti–vascular endothelial growth factor (VEGF) and anti–epidermal growth factor receptor (EGFR) therapies.1 The maximum benefit is achieved during first-line treatment, with diminishing returns from subsequent therapies. Strategies to consolidate the gains from first-line treatment, maintaining disease control while keeping toxic effects to a minimum, are essential. In this regard, the phase 3, randomized OPTIMOX1 study found no difference in efficacy including response rates, progression-free survival (PFS), and overall survival (OS) with deescalation of oxaliplatin after 6 cycles of fluorouracil, leucovorin, and oxaliplatin (FOLFOX) followed by maintenance fluorouracil/leucovorin alone compared with FOLFOX.2 With the reduced incidence of grade 3/4 cumulative peripheral sensory neuropathy in the deescalated arm, the trial influenced clinical practice, with some oncologists now routinely deescalating oxaliplatin but continuing maintenance fluorouracil/leucovorin along with the relevant targeted agent.
Anandappa G, Cunningham D. Panitumumab Alone for Maintenance Treatment in Advanced Colorectal Cancer. JAMA Oncol. Published online July 03, 2019. doi:10.1001/jamaoncol.2019.1447
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