Novel therapeutic approaches for metastatic colorectal cancer

More than 4 decades after its discovery, 5-FU remains an important part of the treatment of colorectal cancer. However, the advent of new agents and the discovery of novel molecular targets have opened a new era in the treatment of this disease. Recent trials of combinations of 5-FU, leucovorin, and either irinotecan or oxaliplatin have produced exciting results that warrant consideration of these regimens as front-line therapies for colorectal cancer. Having produced consistent improvements in response rate, progression-free survival duration, and overall survival duration, the combination of 5-FU, leucovorin, and irinotecan is rapidly becoming the standard against which newer regimens will be compared. Nevertheless, the improvements in survival achieved so far have remained relatively small. Whenever possible, patients should be encouraged to participate in well-designed clinical trials of new regimens. Despite the impressive advances of the past few years, advanced colorectal cancer remains a highly lethal disease.