Chemotherapy for Advanced Colorectal Carcinoma: Fact and Fable

RTT Chan, GKH Au, CC Yau

Hong Kong J Radiol 2002;5:143-54

For more than 40 years, 5-florouracil has been the mainstay of treatment for advanced colorectal carcinoma. Despite its many modulations by other agents or changes in scheduling of its delivery with resultant improvement in response rates, the increase in absolute survival has been modest at best. A generally nihilistic approach has been widely adopted due to this lack of significant improvement and single-agent 5-florouracil remained the cornerstone of therapy for this disease whilst exciting developments with combination chemotherapy have been observed in other tumours, for instance, for breast cancer. The recent introduction of irinotecan and oxaliplatin into the field of colorectal oncology has revolutionised our armamentarium and, at long last, combination chemotherapy becomes a reality for this group of patients. Higher response rates (35 to 55% versus 20%) over regimens with modulated 5-florouracil are now accompanied by a definite increase in overall survival, together with clear documentation of the absence of deterioration in quality of life. Such a development, athough modest, represents a step forward. In this review, the many myths and fables related to the use of chemotherapy for advanced colorectal carcinoma will be appraised and lessons from key international trials will be presented. These facts form the basis for the paradigm shift that is beginning to be locally observed, in the field of colorectal carcinoma.