Area Editoriale
From the 1960s until the mid-1990s, fluorouracil was the primary chemotherapeutic agent available for the treatment of colorectal cancer. During the past decade, the Food and Drug Administration (FDA) has approved five new drugs for metastatic colorectal cancer. Irinotecan (approved in 1996) and oxaliplatin (2002) are cytotoxic agents that interfere with DNA replication, and capecitabine (1998) is an oral formulation of fluorouracil. This spring, the monoclonal antibodies bevacizumab and cetuximab, targeting vascular endothelial growth factor and epithelial growth factor receptor, respectively, were approved by the FDA for use in conjunction with cytotoxic regimens.
Better systemic therapy has considerably improved prognosis. Without chemotherapy, the median duration of survival among patients with metastatic colorectal cancer was eight months. With fluorouracil, it increased to 12 months. After 2002, the availability of three cytotoxic agents (fluorouracil, irinotecan, and oxaliplatin) further extended the median survival to 21 months. Although clinical-trial data are not yet mature, bevacizumab and cetuximab are likely to prolong median survival beyond 21 months. But despite the panoply of options, treatment remains palliative, and there is not yet evidence that the new therapies increase cure rates.In the wake of the optimism generated by recent trial results, patients experience sticker shock when they encounter the prices of chemotherapy drugs
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