Choice of anti-angiogenic agents in second-line treatment in patients with metastatic colon cancer: bevacizumab, aflibercept, ramucirumab (a literature review)

Over the last decade, the possibility of the drug therapy for patients with metastatic colon cancer (mCC) has increased due to the targeted drugs, because most of those drugs have had antiangiogenic activity (bevacizumab, aflibercept, ramucirumab, regorafenib). The combination of chemotherapy and bevacizumab, especially in the patients with mutations in the EGFR signaling pathway, is one of the standard therapy variant in first-line treatment of such patients. However, sooner or later, most patients will develop progression, and no one can say what kind of drugs will be added in 2nd-line treatment in this case. The subject of this review is the difficulty of choosing the sequence of therapy in patients with mCC using antiangiogenic drugs in first-line therapy.