Chemotherapy for colorectal cancer—an overview of current management for surgeons

Background The role of systemic chemotherapy in the management of colorectal cancer has been re-evaluated with the advent of newer agents. The results of published trials are reviewed in this article and the protocols of some of the major ongoing trials outlined. Methods A medline based literature search was performed for articles relating to clinical trials using systemic chemotherapy in the management of colorectal cancer in the advanced and adjuvant setting. Additional original papers were obtained from citations in those identified by the initial search. Results The combination of irinotecan or oxaliplatin with 5-fluorouracil (5-FU) based chemotherapy regimens for advanced cancer demonstrates better response rates when compared with 5-FU and folinic acid (FA). Although this translates into a modest survival benefit, it may increase resectability rates in patients with hepatic metastasis. Adjuvant chemotherapy in stage III cancer has been established to improve long-term survival although it is benefit for patients with stage II disease remains less clear. Conclusion Evaluation of the various combinations of chemotherapeutic agents that are most effective and the clinical situations for which they are best suited is ongoing and will improve the current outlook for those with colorectal cancer.