New approaches for the treatment of colorectal cancer in the adjuvant setting

The value of adjuvant chemotherapy for some patients with stage III colorectal cancer has been established but the situation is less clear for stage II disease. Currently, infusional or bolus 5-fluorouracil (5-FU)/folinic acid (FA) is the treatment of choice but its success is limited and the use of combination therapies is now being investigated. The efficacy of irinotecan in metastatic disease has prompted its use in the adjuvant setting. A number of phase II and randomised phase III trials are investigating the role of irinotecan in combination with capecitabine in the metastatic setting. The role of irinotecan in combination with infusional and/or bolus 5-FU/FA and capecitabine is also under extensive review in the adjuvant setting. Adjuvant therapy with the combination of oxaliplatin/5-FU/FA has been shown to prolong three-year disease-free survival. The overall survival data for this study are not yet available. The use of targeted agents, which are not associated with the toxicities commonly associated with cytotoxic chemotherapy, are being investigated and because of their good safety profile have particular application for this stage of the disease. Biological markers which can help to identify those patients whose disease has a high likelihood of recurrence or those most likely to respond to chemotherapy will help to direct the optimum use of adjuvant therapy. (C) 2004 Elsevier Ltd. All rights reserved.