[Medical therapy of progressive colorectal cancer]

Progress in the systemic treatment of colorectal cancer is evident, not only due to the significant increase in life expectancy in advanced colorectal cancer. It became possible mainly through the consequent and broad clinical introduction of irinotecan and oxaliplatin who should be embraced as standard chemotherapy treatment by now. Oral fluoropyrimidines are on their way to replace parenteral fluorouracil application not only in single drug regimens but also in the new and effective combination protocols. And the innovative concepts of targeted therapies against VEGF and the EGF-receptor have entered clinical treatment. How therapy standards will emerge from the current multiplicity of possible combinations can not be answered yet. The rapid approval of multiple active substances has made the design and completion of clinical trials to answer this question difficult. It has also led to uncertainty in the choice of wich therapy to choose at what time and in wich combination. And escalating costs caused mainly by the use of targeted therapies will seriously challenge the already restricted resources of public healthcare. Carefully defined, individual treatment indications using yet to be developed predictive tools are urgently needed to adress this problem. In conclusion further progress is at the horizon but can only take place through interdisciplinary cooperation and careful design and completion of randomized clinical trials.