[Treatment of metastatic liver carcinoma: chemotherapy and immunotherapy]

The treatment regimens that are considered to be effective against metastatic colorectal carcinoma and available in Japan are levofolinate calcium (Isovorin)/5-fluorouracil (5-FU), irinotecan hydrochloride (Topotecin, CPT-11), and repeated low-dose cisplatin/5-FU. In the USA and Europe, many randomized clinical trials of regimens combining CPT-11 or oxaliplatin (Oxa) with folinate calcium (Leucovorin, LV)/5-FU have been conducted. However, in Japan these three regimens are used sequentially based on the performance status of each patient, and the use of Oxa has not been approved. LV/UFT, and TS-1 will likely be approved soon for colorectal carcinoma. These two regimens may advance the strategy of chemotherapy for colorectal carcinoma. There is no report showing an obvious clinical effect of nonspecific immuno therapy against metastatic colorectal carcinoma. On the other hand, it has been clarified that monoclonal antibodies to the molecular targets such as vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) show a clear clinical effect when they are used together with chemotherapy. It is important to accumulate further evidence clarifying the best chemotherapy for metastatic colorectal carcinoma. Furthermore, it is important that effective molecular-targeting drugs, including the monoclonal antibody to VEGF bevacizumab, become available in Japan soon.