Combination of irinotecan and other drugs in the treatment of colorectal metastatic cancer

As a single agent, irinotecan has demonstrated efficacy in metastatic 5FU r esistant colorectal metastatic cancer Chemotherapy with fluorouracil (5FU) plus leucovorin remains a standard in the treatment of patients with metast atic colorectal cancer It seemed logical to test the combination of this re ference treatment and the new agent The first trials gave rather disappoint ing results, suggesting an inhibition of the metabolism of irinotecan into SN38 when 5FU was Present in the circulation. More recent studies have give n totally different results with a very good tolerance and strong efficacy of the combination of weekly folinic acid + 5FU and irinotecan or LV5FU2 (t he so-called de Gramont regimen) and irinotecan. The results were so good t hat these new schedules are currently developed as first line regimen. Anot her way to combine 5FU, folinic acid and irinotecan is to alternate a cycle of 5FU, folinic acid and a cycle of irinotecan. Such an alternated schedul e hers given encouraging results with an objective response rate greater th an 30% and a long median survival time (more than 16 months). It is also ve ry easy to combine irinotecan with other drugs which have demonstrated acti vity in the treatment of colorectal cancer The combinations of irinotecan a nd mitomycin C or oxaliplatin have given very goon results with high object ive response rates and good tolerance. Irinotecan plays non, an important p art in the treatment of metastic colorectal cancer. This part becomes large r due to the results of the combination trials already presented which have shown strong efficacy and good tolerance.