Reimer P, Rückle-Lanz H
Medizinische Poliklinik, Universität Würzburg.
Med Klin (Munich). 2001 Oct 15;96(10):593-8. doi: 10.1007/s00063-001-1093-9.
Chemotherapeutic options in the treatment of advanced colorectal cancer have markedly improved during the last years. This is partly due to the high-dose 5-FU regimen, but also to the development of new cytotoxic agents and drug combinations.
High-dose 5-FU, irinotecan, and oxaliplatin seem to be superior to low-dose 5-FU in terms of response rate and disease control. Combination of irinotecan with 5-FU/FA showed significant longer overall survival rates compared to 5-FU/FA alone in both published phase III trials. Today most patients are treated by a sequential therapeutic concept using the newer drugs mainly for second or third line therapy. However, there are reasons for the use of more intensive chemotherapy combinations in first line treatment. Combination of oxaliplatin with 5-FU/FA, that failed improvement of overall survival compared to 5-FU/FA alone, could downstage previously unresectable liver metastases for potentially curative surgery in some patients. Oral fluoropyrimidines mark another progress in the treatment of advanced colorectal cancer. They seem to be comparable to low-dose 5-FU/FA and could ease chemotherapy.
Prospective randomized phase III trials must confirm the best chemotherapy and the best strategy for the different subgroup of patients.
在过去几年中，晚期结直肠癌的化疗选择有了显著改善。这部分归因于高剂量5-氟尿嘧啶（5-FU）方案，也得益于新细胞毒性药物和药物组合的开发。
就缓解率和疾病控制而言，高剂量5-FU、伊立替康和奥沙利铂似乎优于低剂量5-FU。在已发表的两项III期试验中，伊立替康与5-FU/亚叶酸（FA）联合使用的总生存率明显长于单独使用5-FU/FA。如今，大多数患者采用序贯治疗方案，主要使用新药进行二线或三线治疗。然而，有理由在一线治疗中使用更强化的化疗组合。奥沙利铂与5-FU/FA联合使用，与单独使用5-FU/FA相比，总体生存率并未提高，但在一些患者中可使先前无法切除的肝转移灶降期，从而有可能进行根治性手术。口服氟嘧啶类药物是晚期结直肠癌治疗的又一进展。它们似乎与低剂量5-FU/FA相当，且可简化化疗。
前瞻性随机III期试验必须确认针对不同患者亚组的最佳化疗方案和最佳策略。
