title: [Clinical practice guideline: 2003 update of Standards, Options et Recommendations for first line palliative chemotherapy in patients with metastatic colorectal cancer (summary report)].
abstract: BACKGROUND
  The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients.
  
  
  OBJECTIVE
  To update clinical practice guidelines for first line palliative chemotherapy in patients with metastatic colorectal cancer previously validated in 1995, then updated in 1997 and published again in 1998. These recommendations do not cover second line treatment.
  
  
  METHODS
  The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been developed, they are reviewed by independent reviewers.
  
  
  RESULTS
  This article is a summary version of the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concerned (1) Which patients should be treated? (2) What is the best treatment duration? (3) Which treatment should be administered? The new data identified concerning which patients to treat and the duration of treatment were consistent with the data presented in the initial report and did not modify the original recommendations from 1997. The new data available represent stronger evidence than those in the original report (Two good-quality meta-analyses published since 1997). A new guideline concerning patients who are 75 years old or more has been added. Concerning, the new evidence identified has modified the guidelines for the therapeutic schema to adopt from 1997. These modifications concern irinotecan, oxaliplatin, oral fluoropyrimidines and methotrexate. Treatment with irinotecan or oxaliplatin associated with continuous 5FU infusion, modulated with folinic acid (LV5FU2-like) has become a standard. The use of oral fluoropyrimidines has become an option for patients who refuse hospitalisation or treatment by infusion. The use of methotrexate combined with 5FU is no longer recommended.
authors.affiliation: Centre Alexis Vautrin, Nancy.
authors.forename: Thierry
authors.initials: T
authors.lastname: Conroy
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gory-Delabaere
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.forename: Lise
authors.initials: L
authors.lastname: Bosquet
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouché
authors.forename: Christophe
authors.initials: C
authors.lastname: Louvet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mitry
authors.forename: Yves
authors.initials: Y
authors.lastname: Bécouarn
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bosset
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
authors.forename: Pierre-Luc
authors.initials: PL
authors.lastname: Etienne
authors.forename: Yacine
authors.initials: Y
authors.lastname: Merrouche
authors.forename: Geneviève
authors.initials: G
authors.lastname: Monges
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D009367:Neoplasm Staging / Q000592:standards; D010166:Palliative Care / Q000592:standards*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil