Infusional 5-FU in the treatment of metastatic colorectal cancer: The 48-hour weekly approach Andrés Cervantes, Eduardo Díaz-Rubio, Enrique Aranda, on behalf of the Spanish Group for Gastrointestinal Tumor Therapy (TTD)

Since its introduction in clinical oncology more than 40 years ago, 5-fluorouracil (5-FU) remains the most useful drug in the treatment of patients with advanced colorectal cancer. Many schedules, dosages and routes of administration have been used for 5FU, not only as a single agent, but also in combination with modulating compounds such as leucovorin (folinic acid), methotrexate, N-(phosphonoacetyl)-Laspartic acid (PALA), interferon, dipyridamole and hydroxyurea, among others. Randomized trials using strict response criteria showed that the objective response rate that may be achieved with 5-FU, given as an intravenous push, lies in the range 10-15%. Despite some advances in the understanding of the metabolic pathways by which 5-FU may eventually produce tumour cell death, the impact of biomodulation on the natural history of the disease is limited, with some improvement in response rate, but without any significant effect on survival.1

However, improvements in tumour-related symptoms are frequently seen, and, for this reason, palliative chemotherapy of metastatic colorectal cancer has a major role to play.