Maintenance Strategies in Metastatic Colorectal Cancer

Maintenance strategies in metastatic colorectal cancer seek to extend disease control after an initial induction phase while reducing cumulative toxicity and preserving quality of life. Following a response to first-line combination chemotherapy—with or without targeted agents—clinicians may de-escalate treatment by withdrawing cytotoxic drugs, continuing a single targeted or biologic agent, or instituting planned treatment breaks. Key approaches include fluoropyrimidine-based monotherapy, anti-EGFR antibody maintenance in RAS wild-type tumours, and VEGF-targeted therapy such as bevacizumab. Intermittent chemotherapy and rechallenge regimens exploit tumour biology and epigenetic plasticity to delay resistance, while evolving biomarkers guide patient selection. Global trials have demonstrated that tailored maintenance can preserve progression-free survival with fewer adverse events than continuous cytotoxic regimens. Practical applications involve molecular profiling to identify candidates for anti-EGFR or VEGF maintenance, incorporation of oral agents such as capecitabine, and consideration of active monitoring with periodic imaging to detect early progression. As survival in metastatic disease improves, maintenance therapy has emerged as a cornerstone of multidisciplinary care, balancing efficacy and tolerability for long-term disease management.

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Maintenance Strategies in Metastatic Colorectal Cancer publication trend

The graph below shows the total number of articles in maintenance strategies in metastatic colorectal cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Maintenance therapy: Reduced-intensity treatment following initial induction to prolong tumour control and limit toxicity.

Fluoropyrimidine: A class of antimetabolite chemotherapeutics (e.g. 5-fluorouracil, capecitabine) used in colorectal cancer.

Anti-EGFR antibody: Targeted biologic therapy against epidermal growth factor receptor, effective in RAS wild-type tumours.

Bevacizumab: A monoclonal antibody targeting vascular endothelial growth factor (VEGF) to inhibit tumour angiogenesis.

Progression-free survival (PFS): Time from treatment start to disease progression or death.

Overall survival (OS): Time from treatment start to death from any cause.

Active monitoring: Surveillance strategy without maintenance drugs, using regular assessments to detect progression.

References

1. Maintenance strategies after anti-EGFR-based induction in metastatic colorectal cancer: A systematic review and bayesian network meta-analysis. Critical Reviews in Oncology/Hematology (2023).
2. Rechallenge therapy and treatment holiday: different strategies in management of metastatic colorectal cancer. Journal of Experimental & Clinical Cancer Research (2013).
3. Capecitabine Versus Active Monitoring in Stable or Responding Metastatic Colorectal Cancer After 16 Weeks of First-Line Therapy: Results of the Randomized FOCUS4-N Trial. Journal of Clinical Oncology (2021).
4. Efficacy and safety of bevacizumab-based maintenance therapy in metastatic colorectal cancer. Medicine (2019).