Planned Treatment Interruptions and Chemotherapy-Free Intervals in the Treatment of Metastatic Colorectal Cancer: Time to Start Stopping?

Studies have begun to examine stop-and-go or intermittent chemotherapy strategies in patients with advanced colorectal cancer. Such strategies potentially may reduce cumulative toxicities associated with long-term therapies. In addition, planned interruptions in treatment would be expected to lower overall costs of treatment, and would clearly offer patients the opportunity to have breaks from oncology visits and associated toxicities of therapy. Greater efforts to define such strategies are necessary, particularly because patients with advanced colorectal cancer now have multiple lines of therapy planned and spend greater amounts of time on treatment. Several studies have suggested that interrupting oxaliplatin or irinotecan treatment may be acceptable in terms of efficacy and beneficial in terms of toxicity. This article will address these and other trials, as well as data relating to incorporation of biologic therapies into combination chemotherapy for patients with advanced colorectal cancer.