[A review of chemotherapy for metastatic colon cancer].
OBJECTIVE
To report and discuss the results of clinical trials published concerning chemotherapy for metastatic colorectal cancer in order to elucidate and define treatment guidelines.


METHODS
The biomedical and pharmaceutical database EMBASE was searched for phase-II and -III clinical trials or metaanalysis that examined chemotherapy for mCRC (January 1998-January 2006).


RESULTS
5-fluorouracil still maintains its preponderant role after 40 years, and its modulation by adding folinic acid or administering it in more prolonged infusions has managed to slightly increase survival in these patients, as well as to improve the drug s toxicity profile. The development of irinotecan first, and then oxaliplatin has lengthened survival by a few months when in combination with 5-fluorouracil and folinic acid-based regimens. All patients should have access to these two drugs guaranteed during the course of the disease, as it will increase survival. Raltitrexed fails to improve survival, and also diminishes quality of life in these patients; hence its use has been relegated to clinical trials. Bevacizumab, combined with classic chemotherapy regimens, attains slightly longer survivals. Results from studies with cetuximab are not that conclusive, and its use should be restricted to patients with relapsing disease after irinotecan and no other treatment options left.


CONCLUSIONS
New drugs for metastatic colorectal cancer open up new therapy lines allowing increasingly improved survival. However, optimal schemes, as well as their order of administration, have yet to be fully devised.
Díez-Fernández
R
R
Servicios de Farmacia y Oncología, Hospital Universitario de Getafe, Madrid, Spain. rdiez.hugf@salud.madrid.org
Salinas Hernández
P
P
Girón-Duch
C
C
D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069287:Capecitabine; D000068818:Cetuximab; D017322:Clinical Trials, Phase II as Topic / Q000706:statistics & numerical data; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D000077146:Irinotecan; D015201:Meta-Analysis as Topic; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D000077150:Oxaliplatin; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016019:Survival Analysis; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D011799:Quinazolines; D013876:Thiophenes; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D000077146:Irinotecan; C068874:raltitrexed; D000068818:Cetuximab; D005472:Fluorouracil; D002166:Camptothecin