Chemotherapy for Colorecal Cancer

Bang, Yung Jue

Abstract

There has been a dramatic change in the chemotherapy of colorectal cancer over the years. It has been clearly demonstrated that chemotherapy of patients with metastatic colorectal cancer is associated with survival prolongation and relief of tumor-related symptoms. The optimal use of 5-fluorouracil (5-FU) in combination with folinic acid (FA), the new drugs such as irinotecan and oxaliplatin, and the oral fluoropyrimidines UFT and capecitabine increased therapeutic options and improved outcome of patients with metastatic colorectal cancer. Combination of irinotecan or oxaliplatin and 5-FU/FA is more active than 5-FU/FA. The oral agents capecitabine and UFT/FA seem to have a comparable activity to intravenous bolus 5-FU/FA with improved patients' tolerance. By the early 1990s, the role of postoperative adjuvant chemotherapy in stage III colon cancer had been firmly established. 5-FU-based chemotherapy has been shown to reduce recurrence and improve survival in patients with stage III colon cancer. However, the use of adjuvant therapy is still debated in stage II colon cancer. At present, 6 months, treatment of 5-FU/FA is the standard adjuvant drug combination. New drugs that have been shown to be active in metastatic colorectal cancer, such as irinotecan, oxaliplatin, and oral fluoropyrimidines, hold promise and are being tested in adjuvant settings. New agents acting on novel molecular targets such as epidermal growth factor receptor inhibitors are expected to play a unique role in the treatment of colorectal cancer in the future.