Factoring drug-free intervals into the management of patients with advanced colorectal cancer

Generally patients with advanced colorectal cancer have several lines of chemotherapy with prolonged survival, and some benefit from surgery for initially unresectable metastasis. This provides strong rationale to study the best strategy to optimize efficacy of the available treatments with the least possible toxicity, so that patients have the best quality of life. Several teams have started to examine different chemotherapy strategies in patients with advanced colorectal disease, including stop-and-go chemotherapy with maintenance therapy, intermittent chemotherapy, and chemotherapy-free intervals. These strategies are expected to reduce cumulative toxicities associated with a continuous chemotherapy until progression occurs in that setting. Breaks in treatment could support a lower overall cost for patients, who receive treatment for a greater duration of time now than they would have 10 years ago. Another approach is to define some patients’ profiles who could benefit from chemotherapy breaks. Both approaches could be linked.