Chemotherapy intensification

Gianluca Masi and Alfredo Falcone1

(1) Department of Oncology, Azienda USL-6 of Livorno Viale Alfieri, 36, 57124 Livorno, Italy

Published online: 8 July 2007

Abstract Today the treatment of metastatic colorectal cancer is based on several treatment options incorporating chemotherapy, targeted agents, and the surgery of metastases, and a median survival of almost 2 years has been reached. Despite these advances and the availability of multiple lines of treatment, the choice of the first-line chemotherapy indeed still matters, and the development of chemotherapy regimens associated with improved efficacy is a key question in the “biologics era.” This review discusses the development of the triple drug combination FOLFOXIRI (irinotecan [CPT-11], oxaliplatin, and 5-fluorouracil [5FU]/leucovorin [LV]). Several phase II trials demonstrated the feasibility of this combination and, more importantly, a phase III trial demonstrated that the triplet FOLFOXIRI is the first studied combination that significantly increases response rate, complete tumor resection of metastases, progression-free survival, and overall survival compared with an infusional 5FU containing doublet, such as FOLFIRI (5FU/LV and CPT-11). Therefore, FOLFOXIRI represents a new first-line option of care for patients with metastatic colorectal cancer.