Abstract
Since colorectal cancer is the second most prevalent cancer worldwide, its treatment remains a major challenge for researchers, gastroenterologists and oncologists. Despite curative resections, half of all patients diagnosed with colorectal cancer die because of their underlying disease. Integral chemotherapeutic components of standard regimens are 5-fluorouracil (5-FU), its modulation by folinic acid and irinotecan or oxaliplatin. All these drugs sequentially given have results in terms of median overall survival of more than 20 months in the palliative treatment of advanced colorectal cancer. Oral fluoropyrimidines, currently under clinical investigation, are likely to substitute continuous 5-FU. Inhibitors of growth factor receptors or their signaling may further prolong disease-free and overall survival rates. Preliminary evidence exists that improved adjuvant and neoadjuvant chemotherapy strategies may further improve the prognosis, mainly because more patients are able to go for primary or secondary surgery with curative intent.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Parkin DM (2001) Global cancer statistics in the year 2000. Lancet Oncol 2:533–543
Landis SH, Murray T, Bolden S, Wingo PA (1999) Cancer statistics, 1999. CA Cancer J Clin 49:8–31
Anonymous (1992) Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. Advanced Colorectal Cancer Meta-Analysis Project. J Clin Oncol 10:896–903
Poon MA et al (1989) Biochemical modulation of fluorouracil: evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. J Clin Oncol 7:1407–1418
Poon MA et al (1991) Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. J Clin Oncol 9:1967–1972
Patel K et al (2004) Weekly 5-fluorouracil and leucovorin: achieving lower toxicity with higher dose-intensity in adjuvant chemotherapy after colorectal cancer resection. Ann Oncol 15:568–573
Anonymous (1998) Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. Meta-analysis Group In Cancer. J Clin Oncol 16:301–308
Goldberg RM et al (2004) A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 22:23–30
Tournigand C et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22:229–237
Moertel CG (1994) Chemotherapy for colorectal cancer. N Engl J Med 330:1136–1142
Maughan TS (2001) Adjuvant chemotherapy for colorectal cancer. Br J Cancer 85:1422–1424
Mamounas E et al (1999) Comparative efficacy of adjuvant chemotherapy in patients with Dukes' B versus Dukes' C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol 17:1349–1355
Anonymous (1999) Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. J Clin Oncol 17:1356–63
Maung K (2003) Integrating oxaliplatin and capecitabine in adjuvant therapy of high-risk colorectal cancer. Clin Colorectal Cancer 3:150–153
Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, Tabah-Fisch I, de Gramont A; Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) Investigators (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350:2343–2351
Wils J, O'Dwyer P, Labianca R (2001) Adjuvant treatment of colorectal cancer at the turn of the century: European and US perspectives. Ann Oncol 12:13–22
Saltz LB et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914
Douillard JY et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355:1041–1047
Giacchetti S et al (2000) Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment ofmetastatic colorectal cancer. J Clin Oncol 18:136–47
De Gramont A et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947
Sobrero A et al (2000) New directions in the treatment of colorectal cancer: a look to the future. Eur J Cancer 36:559–566
Heslin MJ et al (2003) Dihydropyrimidine dehydrogenase (DPD) rapidly regenerates after inactivation by eniluracil (GW776C85) in primary and metastatic colorectal cancer. Cancer Chemother Pharmacol 52:399–404
Wilke H (2002) Future treatment options with capecitabine in solid tumours. Eur J Cancer 38[Suppl 2]:21–25
Van Cutsem E et al (2001) Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol 19:4097–4106
Grothey A, Schmoll HJ (2001) New chemotherapy approaches in colorectal cancer. Curr Opin Oncol 13:275–286
Rothenberg ML (2002) Current status of capecitabine in the treatment of colorectal cancer. Oncology (Huntingt) 16:16–22
Kerr D (2002) Capecitabine/irinotecan in colorectal cancer: European early-phase data and planned trials. Oncology (Huntingt) 16:12–15
Folprecht G, Kohne CH (2004) The role of new agents in the treatment of colorectal cancer. Oncology 66:1–17
Baselga J, Albanell J (2002) Epithelial growth factor receptor interacting agents. Hematol Oncol Clin North Am 16:1041–1063
Tebbutt NC, Cattell E, Midgley R, Cunningham D, Kerr D (2002) Systemic treatment of colorectal cancer. Eur J Cancer 38:1000–1015
Herbst RS, Kim ES, Harari PM (2001) IMC-C225, an anti-epidermal growth factor receptor monoclonal antibody, for treatment of head andneck cancer. Expert Opin Biol Ther 1:719–732
Saltz LB et al (2004) Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol 22:1201–1208
Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, Bets D, Mueser M, Harstrick A, Verslype C, Chau I, Van Cutsem EN (2004) Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. Engl J Med 351:337–345
Taberno JM et al (2004) An international phase II study of cetuximab in combination with oxaliplatin/5-fluorouracil (5-FU)/folinic acid (FA) (FOLFOX-4) in the first-line treatment of patients with metastatic colorectal cancer (CRC) expressing Epidermal Growth Factor Receptor (EGFR). Preliminary results (abstract). Proceedings of ASCO 22:3512
Rougier P et al (2004) Cetuximab+FOLFIRI as first-line treatment for metastatic colorectal CA (abstract). Proceedings of ASCO, 22:3513
Douglass EC (2003) Development of ZD1839 in colorectal cancer. Semin Oncol 30:17–22
Kabbinavar F et al (2003) Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol 21:60–65
Hurwitz HLF et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer.. N Engl J Med 350:2335–2342
Bismuth H et al (1996) Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 224:509–520; discussion 520–522
Giovannini M Percutaneous alcohol ablation for liver metastasis. Semin Oncol 29:192–5 (2002)
Livraghi T et al (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451
Kessler A et al (2002) Minimally invasive techniques in the treatment of liver tumors. Isr Med Assoc J 4:1106–1110
Scaife CL et al (2003) Feasibility of adjuvant hepatic arterial infusion of chemotherapy after radiofrequency ablation with or without resection in patients with hepatic metastases from colorectal cancer. Ann Surg Oncol 10:348–354
Pozzo C, Basso M, Cassano A, Quirino M, Schinzari G, Trigila N, Vellone M, Giuliante F, Nuzzo G, Barone C (2004) Neoadjuvant treatment of unresectable liver desease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol 15:933–939
Giacchetti S et al (1999) Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 10:663–669
Penna C, Nordlinger B (2003) Surgery and local treatments of liver metastases from colorectal cancer: how to improve results. Scand J Surg 92:90–96
Lorenz M et al (1999) Relevance of neoadjuvant and adjuvant treatment for patients with resectable liver metastases of colorectal carcinoma. Langenbecks Arch Surg 384:328–338
Rubbia-Brandt L et al (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15:460–466
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Moehler, M., Teufel, A., Galle, P.R. (2005). New Chemotherapeutic Strategies in Colorectal Cancer. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_28
Download citation
DOI: https://doi.org/10.1007/3-540-27449-9_28
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-23341-1
Online ISBN: 978-3-540-27449-0
eBook Packages: MedicineMedicine (R0)