PLACE OF FIRST-LINE PALLIATIVE CHEMOTHERAPY IN PATIENTS WITH METASTATIC COLORECTAL-CANCER

The prognosis of metastatic colorectal cancer remains poor. The 5-year survival rate is indeed 0 to 7%. The median survival duration is 8 mo nths in patients without disease-related symptoms, and 6 months in pat ients with disease-related symptoms. The true benefit of palliative ch emotherapy to increase the overall survival and the symptoms-free surv ival, has been largely discussed. In patients with disease-related sym ptoms, combinations of 5 fluoro-uracil (5-FU) and a biomodulator (leuc ovorin or methotrexate) have demonstrated a benefit on overall surviva l. In patients with asymptomatic disease, the advantage of systematic chemotherapy is more debatable. Two randomized studies have recently d emonstrated that early chemotherapy yielded increased overall survival , disease-free symptom survival, and quality of life. Consequently, in patients with metastatic colorectal cancer. palliative chemotherapy m ust be performed even at early stages, before the onset of disease-rel ated symptoms. Several regimens can be used ns first line chemotherapy . In patients with good general status, and patients in whom a further resection of metastatic tumors could be possible. intensive regimens seem to be more appropriate. In the other patients, 5-FU-based regimen s or raltitrexed can be proposed. Generally the ''standard'' first lin e regimen seems to currently be LV5FU2 (bolus and continuous infusion of 5FU and leucovorin).