Drug Insight: Metastatic colorectal cancer—oral fluoropyrimidines and new perspectives in the adjuvant setting

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

Abstract

Capecitabine and uracil/ftorafur (UFT) are prodrugs of 5-fluorouracil (5-FU) that can be administered orally. Both drugs have been shown to be as effective as bolus 5-FU and folinic acid (FA), both as adjuvant treatment, and for the treatment of metastatic colorectal cancer. However, as the addition of oxaliplatin to 5-FU has been shown to improve disease-free survival in adjuvant therapy, oxaliplatin/5-FU is currently regarded as the standard adjuvant treatment, rather than fluoropyrimidine monotherapy. For the treatment of metastatic colorectal cancer, improved response rates and prolonged survival have been reported when irinotecan or oxaliplatin was added to 5-FU/FA; a further increase in efficacy was shown when bevacizumab, an antibody to vascular endothelial growth factor, was added to chemotherapy. Studies investigating the substitution of infusional 5-FU with oral compounds in combination therapy (e.g. FOLFOX versus capecitabine/oxaliplatin) are ongoing, but preliminary results in metastatic patients advise caution because of increased toxicity when used with irinotecan, and statistically non-significant trends of a decreased efficacy when used with oxaliplatin. Therefore, the combined use of oral 5-FU prodrugs plus irinotecan or oxaliplatin is not recommended at present. Oral 5-FU prodrugs, however, offer a convenient and less toxic treatment option in adjuvant treatment and in the treatment of advanced colorectal carcinoma in patients who do not want an intensified regimen, those that have contraindications for implanted venous access devices, and those who are not candidates for a combination therapy with irinotecan and oxaliplatin.

Details

Original languageEnglish
Pages (from-to)578-587
Number of pages10
JournalNature Clinical Practice Oncology
Volume2
Issue number11
Publication statusPublished - Nov 2005
Peer-reviewedYes

External IDs

PubMed 16270098
WOS 000233160900010
Scopus 28444465897
ORCID /0000-0002-9321-9911/work/142252004

Keywords

Sustainable Development Goals

Keywords

  • Administration, Oral, Antineoplastic Agents/metabolism, Antineoplastic Combined Chemotherapy Protocols, Camptothecin/analogs & derivatives, Capecitabine, Chemotherapy, Adjuvant, Colorectal Neoplasms/drug therapy, Deoxycytidine/analogs & derivatives, Fluorouracil/metabolism, Humans, Irinotecan, Leucovorin/metabolism, Organoplatinum Compounds/metabolism, Oxaliplatin, Prodrugs/metabolism, Vitamin B Complex/metabolism