[Chemotherapy of advanced colorectal cancers]

The medical treatment of advanced colon and rectum cancer is undergoing a revolution in the light of clinical studies defining the indications for conventional treatments as well as the development of new drugs. In this review, the authors discuss a number of practical questions raised every day by oncological teams. First-line chemotherapy must be administered to patients able to tolerate this treatment by the time of the diagnosis. The standard regiment of 5-FU and folinic acid (FUFOL) is gradually being superseded by more modern regimens, especially based on continuous 5-FU infusion, such as LV5-FU2. New drugs such as oxaliplatin, CPI-11 or tomudex are now available, and their place is currently under evaluation. These new drugs raise the question of the value of second-line chemotherapy, new commonly administered to patients with a persistently good general condition despite escape from first-line treatment. The various possible combinations of new drugs with 5-FU now confirm that current standards will be modified in the near future; while retaining the objective of improving survival, but also quality of life. The progress observed and expected will probably allow the development of more effective adjuvant treatment protocols.