Chemotherapy of nonoperable colorectal liver metastases

Biomodulated 5-fluorouracil-based therapy is the mainstay of treatment for advanced colorectal cancer. Patients with advanced disease do better with chemotherapy than they do without, but the overall survival in these patients is still poor. Combination of infusional and bolus 5-fluorouracil/folinic acid (leucovorin) regimens with newer agents, such as CPT-11 and oxaliplatin, in the fist-line treatment of patients with advanced colorectal cancer, has yielded increased response rates and progression-free survivals. In the case of CPT-11 this has also led to an increase in overall survival. Improved therapy combinations and the delivery of the therapy directly to the liver by hepatic arterial infusion, either alone or in combination with intravenous delivery, all herald an improvement in the clinical outcome of patients with nonoperable liver metastases. These patients should be offered the best chemotherapy option available coupled, where appropriate, with liver resection.