Benefits and Drawbacks of the Use of Oral Fluoropyrimidines as Single-Agent Therapy in Advanced Colorectal Cancer

Abstract

One of the most widely used cytotoxic agents is 5-fluorouracil. The use of infusional regimens has become commonplace and with this has come a realization of the limitations of this mode of administration. A number of oral fluoropyrimidines have been developed. Of these, capecitabine is the most established, with registrations in most countries for breast and colorectal cancer. The trials with this agent have mainly attempted to show equivalence with a "standard" intravenous comparator. In most cases, this endpoint has been met or exceeded. In addition, the trials have demonstrated reduced toxicity (except for hand-foot syndrome), and aspects of patient acceptability and cost-effectiveness have been integrated into these studies. Patients seem to prefer oral therapy but not at the expense of anticancer activity. However, the absence of intravenous access devices and complications associated with their use is a major bonus for oral therapy. The drawbacks are somewhat less obvious. Some patients are concerned that oral therapy is in some way inferior (ie, soft option) to intravenous chemotherapy. Compliance with oral therapy is always questionable. Although very few trials in which compliance has been formally assessed have been performed, the issue of overcompliance has not been addressed; in other words, there may be a problem of patients continuing to take the medication even in the face of toxicity and advice to stop treatment. Oral chemotherapy requires just as much care as intravenous chemotherapy and probably requires more attention to patient education and involvement in care decisions.