IRINOTECAN IN THE FIRST-LINE TREATMENT OF COLORECTAL-CANCER

Irinotecan (CPT-11 [Camptosar]) is currently approved for use as a sec ond-line agent in the treatment of metastatic colorectal cancer. Phase II studies have also shown substantial single-agent activity of irino tecan in the first-line treatment of metastatic colorectal cancer. Res ponse rates appear to be similar to those seen with standard first-lin e regimens, although direct randomized comparisons have not yet been r eported. In the absence of definitive data showing irinotecan to be su perior, its routine use as a single agent in the first-line treatment of colorectal cancer may be hard to justify, given the significant cos t differential between irinotecan and current standard first-line regi ments. Studies exploring combinations of irinotecan with fluorouracil may identify first-line role for these combination regimens. Also, use of specific molecular markers may permit the identification of select ed patients with tumor characteristics that would specifically favor c onsideration of upfront irinotecan monotherapy.