Sequencing of Treatment in Advanced Unresectable Colorectal Cancer

This article reviews the various systemic therapy options for patients with metastatic colorectal cancer (CRC) that is judged to be noncurable. The choice of initial therapy depends on patient preferences, treatment goals, performance status, and presence of comorbid conditions. Whether surgical resection of the primary tumor should be considered in patients who present with metastatic CRC is a matter of controversy. The components of the initial systemic regimen influence the options for second- and third-line options when disease progression occurs during therapy. The standard of practice is often to continue chemotherapy until progression, unacceptable side effects, or death. In patients with incurable CRC, the balance between efficacy, toxicity, and repeated hospital or clinic visits must be discussed with the patient. Although continuous treatment may be appropriate for some patients, intermittent treatment strategies or maintenance with the least toxic agents may be preferable for others. If disease progression occurs during a chemotherapy break or while the patient is on maintenance therapy, previously used agents may be reintroduced provided that preexisting toxicities have resolved.

Target Audience

This activity has been designated to meet the educational needs of physicians, nurses, and pharmacists involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe options for sequencing of treatment in advanced unresectable colorectal cancer
  • Discuss the efficacies and toxicities of various treatment plans with patients who have incurable colorectal cancer
Additional information

Supported by educational grants from sanofi-aventis U.S. and Regeneron Pharmaceuticals; Bayer HealthCare Pharmaceuticals Inc.; Genentech, USA; and Lilly USA, LLC.

Course summary
Available credit: 
  • 1.25 Participation
  • 1.25 Nurse
  • 1.25 Pharmacist
  • 1.25 Physician
Course opens: 
Course expires: 

Jean L. Grem, MD, FACP
Division of Oncology/Hematology
Department of Internal Medicine
University of Nebraska Medical Center
Omaha, Nebraska

Available Credit

  • 1.25 Participation
  • 1.25 Nurse
  • 1.25 Pharmacist
  • 1.25 Physician


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Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing