Oxaliplatin in combination with 5-fluoro-uracil and folinic acid as treatment of metastatic colorectal cancer

Unusual aspect of the development of oxaliplatin was that substantial evide nce of its activity was gathered when used in combination with protracted i nfusion of 5FU combined with leucovorin, preceeding the formal demonstratio n of its single activity in this disease. Phase II triad in previously trea ted patients by 5FU, have shown response rate of 10% with oxaliplatin in mo notherapy and 18,4 to 58% with chronomodulated or bimonthly regimen combini ng oxaliplatin, 5FU and leucovorin. These triad have confirmed additive or synergistic antitumoral effects of this combination. Dose intensity of oxal iplatin may be important in determining the efficacy of the triple agent re gimen. For previously untreated patients, Folfox4 (LV5FU2 + 85 mg/m(2) of o xaliplatin) and chronomodulated regimen have obtained objective response ra te ranged from 51 to 66%, with progression free survival between 8.2 and 11 months and overall survival from 16 to 19 months. A better use of oxalipla tin in combination with 5FU and leucovorin may decrease the dose-limiting t oxicity, i.e. the usually transient sensory neurotoxicity. Patients with in itially unresectable metastases treated with this three-drug combination co uld sometimes underwent complete metastases surgery, Several studies are cu rrently in progress either to confirm the high activity of the LV5FU-oxalip latin combination or to define a strategy based on the best sequence or the best combinations with the other available drugs, irinotecan and raltitrex ed.