Low intensity treatment in metastatic colorectal cancer

The optimal choice of first-line systemic therapy in initially unresectable metastatic colorectal cancer is becoming increasingly complex. Treatment selection and intensity should consider several factors including molecular status, primary tumour location, disease sites and burden, performance status and, importantly, patient preference. Although doublet chemotherapy backbone (a fluoropyrimidine [fluorouracil or capecitabine] and oxaliplatin, or a fluoropyrimidine and irinotecan) is typically recommended for first-line therapy in patients with unresectable metastatic colorectal cancer, the role of both higher intensity triplet chemotherapy (fluorouracil, oxaliplatin, and irinotecan) and lower intensity single-agent fluoropyrimidine chemotherapy have been explored in selected patient populations.