Abstract
Van Cutsem and colleagues recommend that 5-fluorouracil (FU) and folinic acid (FA) in either the weekly ‘Roswell Park’ or the 4-weekly ‘Mayo’ regimen should be standard chemotherapy for colon cancer [ 1 Van Cutsem E. Dicato M. Wils J. et al. Adjuvant treatment of colorectal cancer (current expert opinion derived from the Third International Conference Perspectives in Colorectal Cancer, Dublin 2001). Eur. J. Cancer. 2002; 38: 1429-1436 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar ]. However, although FUFA is undoubtedly the current standard chemotherapy, there is no good evidence to support the recommended regimens. The largest reported study establishing survival benefits from FUFA is the International Multicentre Pooled Analysis of Colorectal Cancer Trials (IMPACT) study [ 2 International Multicentre Pooled Analysis of Colorectal Cancer Trials (IMPACT) InvestigatorsEfficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet. 1995; 345: 939-944 Crossref PubMed Scopus (986) Google Scholar ], which used the ‘Machover’ regimen of 370 mg/m2 of FU—which is less toxic than the 425 mg/m2 of FU used in the Mayo regimen. The dose of folinic acid is higher in the Machover regimen, 200 mg/m2 compared with 20 mg/m2, but the large QUASAR (Quick and Simple and Reliable) study has demonstrated, reliably, that the dose of folinic acid is unimportant [ 3 QUASAR Collaborative GroupComparison of fluorouracil with additional levamisole, higher-dose folinic acid, or both, as adjuvant chemotherapy for colorectal cancer: a randomised trial. Lancet. 2000; 355: 1588-1596 Abstract Full Text Full Text PDF PubMed Scopus (239) Google Scholar ]. Moreover, the QUASAR study also strongly suggests that the once weekly schedule of FUFA, using 370 mg/m2 of FU, is just as effective as the 5-day, 4-weekly Machover schedule, but with much less toxicity [ 4 Kerr D.J. Gray R. McConkey C.C. Barnwell J. Adjuvant chemotherapy with 5-fluorouracil, L-folinic acid and levamisole for patients with colorectal cancer non-randomised comparison of weekly versus 4-weekly schedules. Ann. Oncol. 2000; 11: 947-955 Crossref PubMed Scopus (60) Google Scholar ].
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