Evolving Treatment For Colorectal Cancer

For decades, colorectal cancer has been treated primarily with surgery, and provided diagnosis is achieved at an early stage, five-year survival rates are fairly good, at around 80%-90%. In patients with intermediate and advanced disease, surgery is combined with chemotherapy (and also sometimes radiotherapy in rectal tumors), for palliation or to prevent or delay recurrence.

For nearly 40 years, 5-fluorouracil has been the mainstay drug for cytotoxic chemotherapy of patients with colorectal carcinoma, and significant benefits in terms of up to 15% improvements in survival have been demonstrated in patients with intermediate-stage disease. However, the real impact of these advances on the course of CRC remains hidden, as not all patients are referred for adjuvant therapy.

In patients with advanced disease, benefits in terms of improving quality of life and survival have also been documented. 5-FU given weekly or during five consecutive days every four or five weeks is the most widely-used treatment modality, and with doses of around 525mg/m2/week an overall response rate of 12%-17% and a median survival of less than one year is observed. The general well-being of patients, as measured by performance status, weight and ability to resume normal day-to-day activities, can also be significantly improved using chemotherapy.