The medical treatment of colorectal cancer: Actual status and new developments

Colorectal cancer is one of the most frequent malignancies and one of the g reatest causes of cancer death in the Western world. The prognosis is deter mined by the stage at diagnosis. Patients with metastatic colon cancer have a bad prognosis. Chemotherapeutic treatment with 5-Fluorouracil (5-FU) and folinic acid is actually considered as the standard treatment in patients with metastatic disease. Although the survival benefit is relatively small, many patients can benefit from this treatment in terms of tumor regression or symptom improvement. Several new drugs are actually in development and create hope for improved tumor or symptom control and longer survival. Thym idylate synthase inhibitors (raltitrexed), topoisomerase I inhibitors (irin otecan), the oral 5-FU prodrugs (capecitabine, UFT), ethynyluracil, and oxa liplatin are promising new drugs. The challenge will be to determine the be st combination of these new drugs and the exact sequence in which these dru gs will be used. Adjuvant post-operative chemotherapy in colon cancer is one of the most imp ortant advances in oncology that has been introduced into the clinic during the last years. For rectal cancer, an adjuvant treatment should consist of a combined chemo-radiotherapy. The search for better prognostic factors fo r recurrence should help to focus on a better adjuvant treatment for patien ts with the highest risk for recurrence.