Current treatment modalities in advanced colorectal carcinoma.
Several biochemical and immunological substances are currently being tested for their efficacy in the treatment of advanced colorectal cancer, the second-most malignant disease in the western world. Presently, a combination of 5-fluorouracil (FU) and the biochemical modulator folinic acid is considered to be the standard treatment for this malignancy, with a median response rate of 30%. A recent multi-analysis of phase III trials with methotrexate and FU versus FU alone has demonstrated a statistically significant doubling of the response rate as well as a significant survival advantage for the combination. So far, other biochemical or immunological modulators of FU have not shown a significant advantage regarding response or survival. Several new drugs such as tegafur, thymidilate synthase inhibitors, trimetrexate, or topoisomerase-I-inhibitors have been tested with promising results in preclinical and early clinical settings. While local treatment such as hepatic artery infusion has become safer, it is still more toxic than systemic treatment and showed a significant improvement of response but no survival advantage. Since all treatment strategies in advanced colorectal cancer are still palliative, quality of life is a more important endpoint in clinical trials.
Medical Department I, St. Joseph Hospital, Berlin, Germany.
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Hilgenfeld
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M
Streit
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E
Thiel
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ED
Kreuser
D015179:Colorectal Neoplasms / Q000378:metabolism / Q000523:psychology / Q000628:therapy*; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D011379:Prognosis; D011788:Quality of Life
D007372:Interferons; D005472:Fluorouracil; D008727:Methotrexate