ABSTRACT
The next step will obviously be the assessment of these drugs in the adjuvant setting, and for this purpose large-scale cooperative trials are needed.
Studies investigating best supportive care in patients with metastatic colorectal cancer reported a median survival of approximately 6 months and 7-11 months for good-risk patients with tumour confined to the liver only. Data from chemotherapy trials with bolus 5-fluorouracil (5-FU) plus leucovorin (LV, folinic acid) in the 1980s and early 1990s reported a median survival of usually not more than 12 months. The new generation of trials using infusional 5-FU programmes consistently observed a median survival exceeding 15-16 months. These data may reflect a stepwise progress that has been achieved over time, through the development of chemotherapy mainly from bolus to infusional 5-FU. The first experience with irinotecan or oxaliplatin in first-line treatment
in combination with infusional 5-FU appears to indicate a further improvement in treatment outcome. In the studies assessing the addition of oxaliplatin to infusional 5-FU/LV, no significant survival differences were detected,1,2 which could be explained partly by crossover treatment upon relapse. In the trial conducted by the Aventis company that compared infusional 5-FU/LV with infusional 5-FU/LV plus irinotecan, a significant survival difference was detected, the relative improvement in median survival being 23% (14.1 versus 17.4 months).3
