**Author details**

*Multidisciplinary Approach for Colorectal Cancer*

cancer who received MMC (6 mg/m2

therapy and had metastases in multiple locations.

capecitabine (1000 mg/m2

reimbursed.

73–74].

**7. Conclusions**

**Conflict of interest**

thymidine phosphorylase, an enzyme converting capecitabine to 5-FU, is the primary mechanism through which MMC acts synergistically to capecitabine [67]. According to literature, overall response rate in patients with metastatic colorectal

free interval) ranged between 15.2 and 55.5% [68–72]. The majority of patients received previously two, three, or even four lines of anticancer therapy. Median PFS varied between 1.7 and 5.4 months [68–71, 74] and median OS between 5.4 and 13 months [68–72, 74]. While those results might be considered disappointing, it should be emphasized that all patients were pretreated with many lines of systemic

With no doubt, the combination therapy with capecitabine and MMC is dedicated primarily for patients with cumulative side effects after previous treatment and/or contraindications to targeted therapies [70]. Furthermore, capecitabine plus MMC constitutes a good option of the best supportive care in patients who still maintain good performance status and organ efficiency, especially in countries in which regorafenib and TAS-102 have been registered but are not

Toxicity of capecitabine plus MMC combination is mild, acceptable, and easily manageable, and no significant hematological AEs have been reported thus far [71, 73–74]. The main non-hematological AEs documented in patients treated with this regimen are palmar-plantar erythema, nausea, diarrhea, and fatigue [71,

Regorafenib and trifluridine/tipiracil have been authorized for the treatment of metastatic colorectal cancer, as the third or further therapy line. The patients are eligible for one of those treatments if they present with good performance status and adequate bone marrow, liver, and kidney function; hence, aside from clinical and molecular biomarker status, also those factors should be considered during patient qualification. While the toxicity of both anticancer agents is manageable, appropriate control of side effects requires clinical vigilance and good medication compliance. In some clinical situations, re-induction/re-challenge of previously given chemotherapy with oxaliplatin or irinotecan-based regimens and/or switch-

ing to mitomycin C plus capecitabine might be a reasonable option.

The author declares no conflict of interest.

intravenously on day 1 every 3 weeks) plus

twice daily on days 1–14, followed by a 7-day treatment-

**86**

Aneta L. Zygulska Department of Oncology, University Hospital in Krakow, Poland

\*Address all correspondence to: zygulska@poczta.onet.pl

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
