Advances in chemotherapy against advanced or metastatic colorectal cancer

Digestion
Kenji Omura

Abstract

In the early 1990s, some prospective controlled trials revealed the superiority of chemotherapy for survival compared with best supportive care for advanced or metastatic colorectal carcinoma. Until recently, 5-fluorouracil (5-FU) and leucovorin (LV) were the standard therapies against advanced or metastatic colorectal cancer. Theoretically, LV should increase the antitumor activity of 5-FU, although this effect of LV addition has been controversial. A meta-analysis which analyzed 21 randomized controlled trials revealed that a combination of 5-FU and LV doubled the response rate compared with 5-FU alone (from 11 to 21%) and prolonged the median survival time by about 1 month (from 10.5 to 11.7 months). Chemotherapy against advanced or metastatic colorectal cancer has steadily advanced after the introduction of triplet regimens containing 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin (CPT-11) and (trans-R,R-1,2-diamine cyclohexane)oxalatoplatinum(II) (L-OHP). For LV/5-FU/CPT-11, the regimen in which 5-FU is administered with continuous infusion (FOLFIRI) is preferred compared with the 5-FU bolus infusion. According to the results of the randomized controlled trial comparing FOLFIRI followed by FOLFOX6 and t...Continue Reading

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