Chemotherapy of colorectal cancer.

Several randomized trials have shown superior response rates for 5-fluorouracil (5-FU) combined with folinic acid as compared to 5-FU alone. Both treatment regimens are well tolerated and generally can be applied in an outpatient setting. To date no other tested drug combination as methyl-CCNU (M), vincristine (O) and 5-FU (MOF), cisplatin and 5-FU (DDP/5-FU) or methotrexate and 5-FU (MTX/5-FU) showed any clear advantage over 5-FU alone. Regional infusion therapy for liver metastasis from colorectal cancer has not been proven superior as yet to systemic therapy with respect to overall survival. Regional chemotherapy is still considered an experimental approach and should only be performed within controlled trials. New results of postoperative adjuvant chemotherapy with the MOF-schedule for colorectal cancer with Dukes stage B and C demonstrated an improvement in disease-free survival and overall survival for patients, who had undergone resection with curative intent. Trials are under way to examine, whether 5-FU combined with folinic acid is superior to the more toxic MOF-regimen in postoperative adjuvant chemotherapy of colorectal cancer. Eligible patients should only be treated within prospective randomized trials.