Optimal delivery of cytotoxic chemotherapy for colon cancer

Colon cancer is treated adjuvantly with 5-flourouracil (5-FU) and oxaliplatin, most commonly as part of the FOLFOX regimen, which has less toxicity than the older regimen FLOX (bolus 5-FU and oxaliplatin) that has fallen out of favor. For patients who cannot tolerate oxaliplatin, 5-FU can be given as a single agent. Patients with metastatic disease may be treated with a number of regimens, including FOLFOX and FOLFIRI; however, the environment is a not a monotonous vanilla and chocolate FOLFOX and FOLFIRI. Cytotoxic agents, sequentially or in combination, are frequently combined with biologic agents to improve response in metastatic disease. Clinical investigators have focused considerable attention on how best to apply all the agents active in metastatic colon cancer, a practice in evolution. In this article, we highlight important, informative research regarding cytotoxic chemotherapy for colon cancer. We also recognize the contribution made by skilled surgeons, interventional radiologists, and radiation oncologists who will push the envelope and as well, the pharmacogenomic and molecular markers that help us to understand mechanisms of disease, predict toxicity, and refine our therapy.