[First line chemotherapy of advanced colorectal cancers]

Nearly six patients out of ten have or will have colorectal metastasis. A first line chemotherapy is justified as patients' survival duration, quality of life and life without symptoms will be longer and as antitumor efficacy is real. Among classical 5-FU based intravenous chemotherapies, the 5-FU plus folinic acid combination should be preferred to the 5-FU plus methotrexate combination, the latter being difficult to survey. If continuous 5-FU infusions induce more responses than 5-FU bolus alone, they are similar to 5-FU bolus plus folinic acid, but more expensive to realise. Practically, the french chemotherapy protocol that we recommend in first line is a combination of bi-weekly 5-FU bolus plus continuous 5-FU infusion plus folinic acid, which has more efficacy and which is really less toxic than other 5-FU modulations. Among the new drugs available, raltitrexed is the only one authorized by the French government in first line therapy. Other therapeutic ways are possible as hepatic intra-arterial chemotherapy (for some special cases). The future consists of pursing trials to evaluate chronomodulated chemotherapy, individual adjustment of 5-FU dose, and new drugs.