[Oxaliplatin in combination with non fluoropyrimidine drugs in colorectal cancer]

After decades of exclusive use of fluorouracil in the treatment of metastatic colorectal cancer, three new drugs, among them oxaliplatin, have recently shown interesting results. Oxaliplatin has an activity when it is given alone but this drug is particularly interesting for combination chemotherapy because it has a favourable toxicity profile without important haematologic or digestive toxicities and because it has a convenient schedule of administration (short infusion every two or three weeks). Phases I and II studies have demonstrated the feasibility of the combination of raltitrexed and oxaliplatin. A recent phase II study has evaluated the efficacy of this new combination in 71 non pre-treated patients. The observed response rate was high: 59.5%. The combination of oxaliplatin and irinotecan has been assessed in three phase I studies (two with a three-weekly schedule and the last one with a biweekly schedule). These studies have determined the doses which could be used in further phase II studies, these doses were close to the doses used in monotherapy. Results of the efficacy of the three-weekly schedule are available only in second line therapy, with 42% of objective response rate in 36 patients. The dose intensity was maintained with the use of hematopoietic growth factors. These new combinations with oxaliplatin give us the opportunity to treat the patient with schedules excluding fluorouracil which has a variable metabolism.