Colorectal cancer - Disease management considerations

Colorectal cancer is still a major health and social problem. However, many important advances in treatment have been made in the last 4 to 5 years, a nd more optimism is now justified both among clinicians and patients. In surgically resectable disease, adjuvant chemotherapy has been clearly de monstrated as able to increase overall survival in patients with colon canc er Dukes' stage C, whereas the role of medical treatment in patients with D ukes' stage B colon cancer is still controversial. At present, the standard regimen is bolus fluorouracil (5-FU) modulated by folinic acid (leucovorin ) for 6 months. For rectal cancer, the best adjuvant treatment seems to be represented by radiotherapy (better if administered preoperatively) combine d with chemotherapy (usually based on modulated or continuously infused 5-F U). In advanced disease, many new drugs have recently emerged: the most active regimens are those combining an optimal modality of 5-FU administration (i. e. continuous infusion) and one of the most active innovative compounds (ir inotecan or oxaliplatin). The role of the oral drugs (e.g. tegafur/uracil, capecitabine) is still under investigation as is the combination of agents excluding 5-FU. It is now recognised that first-line treatment must be offe red to all suitable patients, even though asymptomatic, and that a second-l ine therapy (chiefly with irinotecan) is of value in many patients with can cer that progresses during treatment with 5-FU. From a strategic point of v iew, the best sequence of drugs/regimens has not yet been defined, while th e duration and timing of chemotherapy is still a matter for clinical resear ch. Finally, there is an increasing interest in the role of biological prognost ic factors as an aid to a patient-tailored therapy, both in the adjuvant se tting and in advanced disease. To achieve further progress in knowledge in this field, we strongly recomme nded that more and more patients are included in clinical trials.