Recent advances in systemic chemotherapy of metastatic colorectal cancer

Colorectal cancer is the second most common cancer in the Western world. Nearly 6 out of 10 patients with colorectal cancer have or will have metastasis, and among patients with advanced disease, the liver is the most common site involved (in up to 70% of patients). Chemotherapy of advanced CRC was long considered as ineffective. Recently, however, chemotherapy has made great strides: a number of successful regimens have been reported especially since 1990. The first randomized trials showing a significant extension of survival in patients treated by chemotherapy as compared to those receiving only supportive care were published in 1992 and 1993. This article provides an up-to-date overview of palliative chemotherapy for metastatic colorectal cancer: tumor reduction is two times greater when 5FU is administered in combination with folinic acid or with Methotrexate than when it is administered alone. According to some studies, these combinations may also significantly improve the duration and quality of survival. Two recent controlled studies comparing systemic chemotherapy with supportive care showed a significant improvement in the duration of survival and a study in asymptomatic patients indicated a significant extension of the duration of the symptom-free period. Hepatic intra-arterial chemotherapy significantly prolongs survival but toxicity is high. Further clinical testing is needed to evaluate new agents, improve tolerance to treatment, and evaluate chemotherapy as a bridge to surgery for patients with initially inoperable metastasis.