title: New developments in systemic chemotherapy in advanced colorectal cancer.
abstract: BACKGROUND
  The majority of patients with newly diagnosed colorectal cancer who present with concurrent metastases are considered to be incurable from the disease. For their treatment, these patients depend on systemic anticancer therapy and supportive care.
  
  
  METHODS
  This article reviews recent developments in systemic treatment of disseminated colorectal cancer.
  
  
  RESULTS
  Until recently, the fluoropyrimidines were the only cytotoxic drugs available, but during recent years three other classes of active conventional cytotoxic drugs and a new class of target-directed drugs have become available. New cytotoxic drug therapies include raltitrexed, irinotecan and oxaliplatin. Patients receiving irinotecan experience a better quality of life than those treated with best supportive care alone. Irinotecan or oxaliplatin in combination with 5-fluoro-uracil (5-FU) and leucovorin are currently the most active treatment regimens. Oral prodrugs of 5-FU, such as capecitabine and uracil, have been developed in order to mimic the protracted infusion schedule of 5-FU, and these drugs may change the daily practice of palliative chemotherapy for colorectal cancer in the coming years. Therapeutic agents that target specific molecular processes that promote proliferation, vascularization and metastasis, and inhibit apoptosis, are being designed and may offer a rational approach to anticancer therapy. Examples of this novel approach are monoclonal antibodies and small molecules adhering to the epithelial growth factor receptor and vascular endothelial growth factor receptor in order to inhibit growth stimulation and angiogenesis.
  
  
  CONCLUSIONS
  The current debate is no longer whether to use palliative chemotherapy in metastatic colorectal, but which patient will benefit from which combination and in what sequence.
authors.affiliation: Dept. of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands. a.cats@nki.nl
authors.forename: A
authors.initials: A
authors.lastname: Cats
mesh_terms: D000284:Administration, Oral; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069287:Capecitabine; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D000077146:Irinotecan; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011799:Quinazolines / Q000008:administration & dosage; D005641:Tegafur / Q000008:administration & dosage; D013876:Thiophenes / Q000008:administration & dosage; D014498:Uracil / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D011799:Quinazolines; D013876:Thiophenes; D000077150:Oxaliplatin; D003841:Deoxycytidine; D005641:Tegafur; D000068258:Bevacizumab; D014498:Uracil; D000069287:Capecitabine; D000077146:Irinotecan; C068874:raltitrexed; D000068818:Cetuximab; D005472:Fluorouracil; D002166:Camptothecin