Metastatic colorectal cancer: integrating irinotecan into combination and sequential chemotherapy.

摘要: The chemotherapy of metastatic colorectal cancer (CRC) has undergone a succession refinements. Through the biochemical modulation 5-fluorouracil (5-FU) with folinic acid (FA), use infusional rather than bolus regimens and combination 5-FU/FA other active agents (notably irinotecan), first-line response rates (RRs) 40% can be achieved, patients surviving up to 17 months. Significant benefits on survival are also seen second-line chemotherapy. question how best sequence was addressed in recent trial which were randomized receive either an irinotecan-based (FOLFIRI) followed by oxaliplatin-based (FOLFOX), or two reverse order. In both arms, RRs greater 50% median exceeded 20 primary end point time progression after lines treatment, this not significantly different. However, FOLFIRI FOLFOX appears preferable because better tolerability use. Use FOLFIRI/FOLFOX is supported chance FOLFOX. Concern been expressed about safety irinotecan combined 5-FU/FA. Infusional have risk/benefit ratio regimens. adverse event profile approaches manageable, plus considered one standard care CRC.