Systemic chemotherapy for colorectal cancer: a narrative review
- Author:
Jun-Eul HWANG
1
Author Information
- Publication Type:Focused Issue of This Month
- From:Journal of the Korean Medical Association 2025;68(12):818-823
- CountryRepublic of Korea
- Language:Korean
- Abstract: Colorectal cancer remains a significant global health challenge and is a leading cause of cancer-related morbidity and mortality. Despite major advances in precision medicine enabled by next-generation sequencing, conventional chemotherapy continues to play a crucial therapeutic role. Since 5-fluorouracil demonstrated clinical efficacy, a wide range of chemotherapeutic agents has been developed, including immune-oncologic drugs such as immune checkpoint inhibitors.Current Concepts: FOLFIRI or FOLFOX, with or without bevacizumab or cetuximab, have become standard first-line treatment options for medically fit patients with stage IV colorectal cancer. More recently, immune checkpoint inhibitors have been adopted as first-line therapy for patients with microsatellite instability-high colorectal cancer. Upon disease progression after FOLFIRI or FOLFOX with or without bevacizumab or cetuximab, agents such as regorafenib, trifluridine–tipiracil, fruquintinib, and other targeted therapies directed at specific genomic alterations may be considered.Discussion and Conclusion: Chemotherapy for colorectal cancer has advanced rapidly in recent years, largely driven by improvements in genetic analysis technologies. Numerous chemotherapeutic agents have been developed or are currently under investigation, including immune checkpoint inhibitors and targeted therapies for specific genomic alterations. Nevertheless, only a small proportion of patients harbor actionable genomic alterations, and the overall clinical benefit remains limited. From a clinical perspective, it is essential to rapidly acquire up-to-date knowledge, communicate effectively with patients, and actively participate in clinical trials that provide access to novel therapeutic agents.
