[Role of first-line palliative chemotherapy in metastatic colorectal cancer]

The prognosis of metastatic colorectal cancer remains poor. The 5-year survival rate is indeed 0 to 7%. The median survival duration is 8 months in patients without disease-related symptoms, and 6 months in patients with disease-related symptoms. The true benefit of palliative chemotherapy to increase the overall survival, and the symptom-free survival, has been largely discussed. In patients with disease-related symptoms, combinations of 5 fluoro-uracil (5-FU) and a biomodulator (leucovorin or methotrexate) have demonstrated a benefit on overall survival. In patients with asymptomatic disease, the advantage of systematic chemotherapy is more debatable. Two randomized studies have recently demonstrated that early chemotherapy yielded increased overall survival, disease-free symptom survival, and quality of life. Consequently, in patients with metastatic colorectal cancer, palliative chemotherapy must be performed even at early stages, before the onset of disease-related symptoms. Several regimens can be used as first line chemotherapy. In patients with good general status, and patients in whom a further resection of metastatic tumors could be possible, intensive regimens seem to be more appropriate. In the other patients, 5-FU-based regimens or raltitrexed can be proposed. Generally, the "standard" first line regimen seems to currently be LV5FU2 (bolus and continuous infusion of 5FU and leucovorin).