Colorectal cancer in 2003: state of the art and new developments

Abstract

Colorectal cancer (CRC) accounts for 10–12% of all cancers and is second in the league of cancer deaths for men and women in western countries. In Western Europe there were more than 200,000 new cases of CRC and over a 100,000 deaths in the year 2000. Despite increased knowledge about the etiology of the disease and improved treatment strategies nearly 50% of patients still die of their disease. Furthermore, the main cause of death is not recurrence at the primary site, but disease spread, predominantly to the liver. The 5-year survival for patients with metastatic CRC is less than 5%, and while patients with resectable metastases have a 5-year survival of 30%, resectable patients currently represent only 15–20% of patients with liver metastases. The standard therapy for patients with advanced CRC remains palliative 5-fluorouracil (5-FU)-based systemic chemotherapy, which is administered with the aim of improving survival and quality of life (QoL). New combination regimens such as irinotecan/5-FU/folinic acid (FA) and oxaliplatin/5-FU/FA have improved survival [1–5] (Table 1). The recently reported EORTC trial of K€ ohne et al. [5] using irinotecan in combination with the German AIO 5-FU/FA regimen, has produced one of the highest median survival times for first-line chemotherapy in this setting with a median survival time of 20.1 months. The recently published study of the sequential administration of two combination regimens showed that the two regimens FOLFIRI (irinotecan/ 5-FU/FA [modified de Gramont]) and FOLFOX (oxaliplatin/5-FU/FA [modified de Gramont]) were essentially similar with both achieving high response rates (RRs) and impressive survival when either regimen was administered first-line followed by the other second-line [6]. Patients receiving FOLFIRI followed by FOLFOX achieved a RR of 56% first-line with a median overall survival (OS) of 21.5 months whilst patients receiving FOLFOX followed by FOLFIRI achieved a RR of 54% and a median OS of 20.6 months Table 2 [6]. These