Chemotherapy of large intestinal carcinoma. Current results and future prospects

Abstract

Chemotherapy of advanced stages of large bowel cancer has until recently made little progress since the introduction of 5‐FU 16 years ago. While survival is improved for patients who respond, 5‐FU alone has made little impact on life span of the overall population of patients. Mitomycin‐C and the chloroethyl nitrosourea antitumor agents, and in particular methyl‐CCNU, have also demonstrated marginal activity in large bowel cancer. Two recently reported controlled clinical trials of combination chemotherapy have demonstrated response rates that are substantially better than those obtained with 5‐FU alone: a 43% response rate in colorectal carcinoma has been reported using a combination of 5‐FU, BCNU, vincristine, and DTIC, compared to a 25% response with 5‐FU as a single agent; a 44% objective response rate with a combination of 5‐FU, methyl‐CCNU, and vincristine has been reported to be significantly better than 5‐FU alone, 5‐FU as an adjuvant following surgical resection with curative intent has not prevented tumor relapse; however, it is hoped that future studies employing more effective drug combinations will result in increased numbers of patients achieving disease‐free survival.