Update on chemotherapy for advanced colorectal cancer

Efforts to improve the length and quality of life, as well as to expand treatment options, for patients with metastatic colorectal cancer have only recently become more successful. With maximization of dose and schedule schemes for fluoropyrimidine therapy, new drugs such as irinotecan (CPT-11, Camptosar) and oxaliplatin have also become part of the standard therapy for patients. Combination chemotherapy has been established to have superior response rates and progression-free survival and--in some instances, for fluorouracil and irinotecan combinations--improved overall survival compared to fluorouracil alone. There is still much to be learned about the optimal management of patients with colorectal cancer, including the role of second- and third-line chemotherapy in the overall survival outcome, and the role of salvage therapy in patients with limited metastatic disease. Most importantly, the development of a biological marker of prognosis and response should help to select appropriate chemotherapy programs for patients on a rational and individual basis, not only in the setting of metastatic disease, but also in the adjuvant population.