[Chemotherapy of advanced colorectal cancers after failure of a treatment with fluoropyrimidine].

Second line chemotherapy is more and more frequently indicated in advanced colorectal cancer. Many patients are still in good general condition at the time of tumor progression. Several options can be discussed today, and particularly new drugs which have recently proved to be active in this situation. Irinotecan, a camptothecin derivative and specific inhibitor of the enzyme topoisomerase I has been approved in this indication and is able, with acceptable toxicity under careful monitoring, to provide a significant proportion of patients with 6 to 8 additional months of progression-free survival. Oxaliplatin, the first clinically available compound of the DACH-platine family, which has specific and original pharmacologic and clinical properties, can also be used alone or preferably in combination with further fluorinated pyrimidines potentiated by folinic acid. Alternative schedules of fluorinated pyrimidines such as low doses continuous infusions of fluorouracile can finally be an option in poor prognosis patients since the drug has a different mechanism of action as compared to the high dose intermittent or modulated schedules.