[Chemotherapy of colonic carcinoma in the year 2001]

The systemic anticancer drug therapy is indicated in the adjuvant as well as in the palliative setting. There is an indication for an adjuvant therapy in case of Dukes B (stadium II) as well as in Dukes C (stadium III) colon cancer. An indication in the palliative setting remains for the Dukes D (stadium IV) colon cancer patients. Locoregional chemotherapeutical approaches represent no standard procedure and cannot be recommended outside clinical trials because the real value of this therapy is unknown due to a lack of large randomized trials. The mainstay of treatment of colon cancer is 5-Fluoruracil (5-FU), which should be combined with folinic acid in case of bolus (2-4 min. injection) therapy. In the adjuvant situation the Mayo scheme administered over a period of half a year remains the standard of choice because this procedure is validated by large randomized trials and replaces the combination 5-FU + levamisol given over a period of one year in former times. In the palliative situation 5-FU based therapy remains the goldstandard although more options than 5-FU plus folinic acid are now available. Oxaliplatin and irinotecan are approved for the treatment of metastatic colon cancer in first line in combination with 5-FU. Capecitabine and Ralitrexed are drugs, which are approved outside of Germany and can be used as well if indicated. The median survival of patients with metastatic colon cancer is between 12 and 18 month. It will be discussed in which way this range depends on the chemotherapeutical strategy.