OBJECTIVES: The objective of this study was to assess the oncologists' real clinical practice in the management of mCRC patients, with a focus on the 3rd, 4th and later lines of therapy in Italy. METHODS: Data presented in this study were collected from medical records obtained by Italian oncologists on mCRC patients between March and April 2014 and retrieved from an extra boost of ONCOVIEW database. ONCOVIEW is a continuous syndicated study on cancer treatment in the hospital setting, based on the collection of patient questionnaires. Patients inclusion criteria were the presence of an mCRC diagnosis, 3rd or later actual therapy line and no participation in a phase II or III clinical study. Information collected included patient demographic characteristics, mCRC characteristics (TNM Classification, Karnofsky performance status scale and mutation analyses) and treatments (actual and previous schedules, dosages and durations). Furthermore, an evaluation of the "Rechallenge" occurrence, in other words the use in 3rd or later line of treatment of drugs previously used, has been performed.  RESULTS: of treatment, while 43 patients were in 4th or later treatment line. The most administered schema among third line patients was Capecitabine alone (63 patients), while the most used schema in fourth line was a combination of Fluorouracil and Folinic Acid (7 patients). About 40% of molecules administered in 3rd line and 67% of molecules administered in 4th line were used in previous lines CONCLUSIONS: Results from the present study underline the unmet medical need in 3rd or later line of treatment of mCRC patients and the need for additional evidence-based treatment options.