Chemotherapy in colorectal cancer: new options and new challenges

Colorectal cancer is the second most common cause of cancer-related mortality in Europe and North America. Studies conducted in the last two decades have established the role of adjuvant therapy in stage III colon cancer. However, there is currently no international consensus with the role of adjuvant treatment in stage II disease. The introduction of irinotecan, oxaliplatin, oral fluoropyrimidines and raltitrexed has broadened the treatment options available for patients with advanced colorectal cancer. The integration of these drugs with the new molecular targeted therapies such as epidermal growth factor receptor, cyclooxygenase, angiogenesis and matrix metalloproteinase inhibition will form the basis of clinical research in the next few years and may, in the future, impact on the survival of patients with colorectal cancer. This review will focus on the place of chemotherapy in colorectal cancer, but not its role in combination with radiotherapy in rectal cancer.