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Current treatment modalities in advanced colorectal carcinoma
R U Hilgenfeld1, M Streit, E Thiel
1Medical Department I, St. Joseph Hospital, Berlin, Germany.
Summary
Methotrexate combined with 5-fluorouracil (FU) significantly improves response and survival rates in advanced colorectal cancer patients. Other FU modulators and local treatments show limited benefits, emphasizing palliative care and quality of life.
Area of Science:
- Oncology
- Pharmacology
- Cancer Research
Background:
- Advanced colorectal cancer is a leading cause of mortality worldwide.
- Current standard treatment involves 5-fluorouracil (FU) with folinic acid, yielding a 30% response rate.
- Investigating novel therapeutic agents is crucial for improving patient outcomes.
Purpose of the Study:
- To review current and emerging treatments for advanced colorectal cancer.
- To evaluate the efficacy of biochemical and immunological modulators of FU.
- To assess the role of local versus systemic treatments and quality of life as an endpoint.
Main Methods:
- Analysis of multi-center phase III trials.
- Review of preclinical and early clinical data for new drugs.
- Comparison of local treatment (hepatic artery infusion) with systemic therapy.
Main Results:
- Combination of methotrexate and FU demonstrated a doubled response rate and survival advantage over FU alone.
- Other FU modulators have not shown significant improvements in response or survival.
- Hepatic artery infusion improved response but not survival, with higher toxicity than systemic treatment.
Conclusions:
- Methotrexate plus FU offers a significant survival benefit for advanced colorectal cancer.
- Newer agents like tegafur and various inhibitors show promise but require further investigation.
- Quality of life is a critical endpoint in palliative care for advanced colorectal cancer.