Holen K D, Saltz L B
Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Lancet Oncol. 2001 May;2(5):290-7. doi: 10.1016/S1470-2045(00)00324-7.
Colorectal cancer is the second leading cause of cancer death and it is clear that patients with metastatic disease have better quality of life and survival when given treatment. Despite four decades of experience of treating patients with fluorouracil, there remains considerable controversy about the optimum dose and scheduling, as well as biomodulation with leucovorin and methotrexate. However, irrespective of the dose and schedule, overall survival times are poor--about 1 year. Disappointingly, oral agents with similar mechanisms to fluorouracil do not improve survival rates in comparison with fluorouracil and leucovorin treatment. Irinotecan and oxaliplatin are newer agents that have improved the response rates for patients with metastatic disease when they are added to flurouracil and leucovorin. The combination of irinotecan, fluorouracil, and leucovorin has also improved overall survival. These are small advances in the fight against colorectal cancer, and further drug development is necessary.
结直肠癌是癌症死亡的第二大主要原因，很明显，转移性疾病患者接受治疗后生活质量和生存率会更高。尽管有四十年使用氟尿嘧啶治疗患者的经验，但关于最佳剂量和给药方案，以及与亚叶酸和甲氨蝶呤的生物调节作用，仍存在相当大的争议。然而，无论剂量和方案如何，总体生存时间都很短——约为1年。令人失望的是，与氟尿嘧啶和亚叶酸治疗相比，具有与氟尿嘧啶相似作用机制的口服药物并不能提高生存率。伊立替康和奥沙利铂是较新的药物，当它们与氟尿嘧啶和亚叶酸联合使用时，提高了转移性疾病患者的缓解率。伊立替康、氟尿嘧啶和亚叶酸的联合使用也改善了总体生存率。这些都是抗击结直肠癌方面的微小进展，进一步的药物研发是必要的。
