Gastrointestinal cancer: recent developments in medical oncology

Background Progress in the medical oncological treatment of gastrointestinal cancer has resulted from advances in tumour biology as well as randomised clinical trials. This review updates oncologists on developments in perioperative therapy for gastrointestinal tumours, optimal use of chemotherapy for colorectal cancer, and novel targeted monoclonal antibodies (mAbs). Methods The recent literature, including published abstracts, was reviewed with respect to current and developing treatments for gastrointestinal cancers. Emphasis was given to randomised clinical trials published within the last 5 years. Results Randomised evidence exists to support the use of pre-operative chemotherapy in patients with resectable oesophageal cancer and pre-operative chemo-radiotherapy for rectal cancer. There is preliminary randomised evidence to support the use of perioperative chemotherapy for gastric cancer. Adjuvant therapy for pancreatic cancer has been shown to improve survival. Improved disease-free survival for colorectal cancer patients treated with either adjuvant capecitabine or oxaliplatin has been demonstrated. MAbs targeting epidermal growth factor receptor and vascular endothelial growth factor have been shown to improve outcomes in patients with advanced colorectal cancer. Conclusions Multidisciplinary strategies for patients with localised gastrointestinal cancers; and improved systemic therapies for patients with advanced disease are leading to superior patient outcomes. Further improvements are required, and targeted agents may contribute to future progress.