Multimodality Treatment for Colon Cancer Multimodale Therapie des Kolonkarzinoms

Abstract

Summary: Background: Systemic chemotherapy significantly prolongs survival and helps to maintain or improve quality of life in a substantial proportion of patients with colorectal cancer. 5-fluorouracil (5-FU) has been the most important chemotherapeutic agent for more than 30 years. Higher response rates together with better tolerability favour 5-FU continuous infusion (CI) regimens +/– modulation by folinic acid. During recent years the two new drugs irinotecan and oxaliplatin have dramatically expanded the treatment options in colon cancer. Both drugs have shown activity in patients resistant to 5-FU.Methods: A review of recent developments in chemotherapy for colon cancer is presented.Results: Four large randomized studies, which compared 5-FU/LV either with the combination of irinotecan + 5-FU/LV or oxaliplatin + 5-FU/LV as first-line treatment, demonstrated significant increases in response rate and time to progression for the combination therapy. In addition, the two irinotecan studies showed a significant gain in survival. In patients with stage III tumours, 5-FU/LV given for 6 months is able to reduce the recurrence rate by 40 % and the death rate by 30 %. In stage II tumours, although there is at least evidence for the efficacy of chemotherapy, its role is currently not definitively established.Conclusions: In stage III colon cancer, 5-FU/LV for 6 months is currently standard treatment; CI 5-FU regimens seem to be at least equivalent to the well-established bolus schedules. There is evidence for the efficacy of chemotherapy also in stage II colon cancer, but its role is currently not definitively established. Future perspectives include combinations of 5-FU with irinotecan or oxaliplatin in the adjuvant setting and inhibitors of signal transduction such as farnesyl transferase inhibitors or inhibitors of epidermal growth factor receptor.