[Irinotecan for the treatment of metastatic colorectal cancer]

In a dozen years of development, irinotecan (CPT11) became one of major therapeutics in the taking care of the metastatic colorectal cancer (CCRM). First used in monotherapy every three weeks, irinotecan has been later developed in association with 5FU and folinic acid according to two modalities of administration (bolus schedule administred weekly or infused schedule every two weeks). This association is now validated both in first and second line. Infused schedule (Folfiri) seems to introduce the best ratio of efficacy/tolerance. The association with the anti VEGF antibody (Avastin), bevacizumab) is promising. Moreover the association of the irinotecan with the anti EGFR antibody (Erbitux)), cetixumab) has show a efficacy in third line after progression under an protocol with irinotecan. Combinations with oxaliplatine (Irox, Irinox) or (Folfoxiri, Folfirinox) still remain in the course of appreciation notably in neoadjuvant context. An increment of dose seems accomplishable in monotherapy or in combination with/AF (high Folfiri doses) with a notable increment of responses rates. Nevertheless this strategy must again show a true clinical interest. Finally they are at promising developments in the fields of the irinotecan pharmacogenetic and pharmacogenomic.