Place de la trichimiothérapie dans le traitement des cancers colorectaux métastatiques

The role of tri-chemotherapy (tri-CT) (FOLFOXIRI or FOLFIRINOX), alone or in combination with targeted therapy (bévacizumab or anti-EGFR antibodies) in the management of metastatic colorectal cancer is increasing. It has a prominent place in the induction treatment of patients with potentially resectable metastases because it improves the objective response rate and the chances of secondary resection of metastases compared to a bi-CT, but also in patients having a symptomatic disease. In patients with non-resectable metastases, tri-CT, preferentially associated with bévacizumab, may also be proposed as part of a "top-dow" strategy that includes 5-fluorouracil ± bévacizumab-based maintenance therapy after 4-8 cures of induction chemotherapy. Finally, tri-CT plus bévacizumab is the combination of choice in mutated BRAF patients, having a poor prognosis, in whom it provides the best survival results to date. Tri-CT is potentially associated with a higher toxicity than bi-CT, which requires a careful selection of patients who can tolerate it and benefit from it and some prophylactic measures of digestive and haematological toxicities. It can therefore be conceived only as an induction treatment limited to 6-8 cycles generally, or even 12 cycles at the maximum.