[Systemic treatment of colorectal cancers--factual standards and perspectives]

Adjuvant therapy has been shown to reduce recurrence and improve survival in patients with stage III colo-rectal cancer (CRC). However, the use of adjuvant therapy is still much debated in stage II disease. Fluorouracil (5-FU) and folinic acid (FA) are currently the standard adjuvant drug combination. The treatment of patients with metastatic colorectal cance has changed dramatically over the years. The more optimal use of 5-FU in association with FA, the new drugs such as irinotecan and oxaliplatin, and the oral fluoropyrimidines capecitabine and uracil/tegafur(UFT) have contributed to the increased therapeutic option and to improved outcome of patients with metastatic CRC. It has been shown that combination therapy with 5-FU/FA and irinotecan or oxaliplatin is more active than 5-FU/FA in the first line of advanced CRC. The oral fluoropyrimidines capecitabine and UFT/FA seem to have a comparable activity to intravenous bolus 5-FU/FA in the first line treatment of metastatic CRC. New agents acting on novel targets are under development. Epidermal growth factors inhibitors, vascular endothelial growth inhibitors, and cyclo-oxygenase 2 inhibitors might play a role in the future in the treatment of CRC.