RESUMEN

BACKGROUND: Colorectal cancer (CRC) is common in North America. Metastatic disease is present at diagnosis in 30% of the patients, and approximately half of early-stage patients will eventually present with metastatic disease. Until recently, few chemotherapy options were available to treat metastatic CRC. METHODS: The authors review the results of recent clinical trials and the design of ongoing trials in the management of patients with metastatic colorectal cancer. RESULTS: Fluorouracil (5-FU) with leucovorin (LV) modulation has a marginal but positive effect on survival in those patients. The recent incorporation of irinotecan (CPT-11) and oxaliplatin for the management of advanced CRC has generated further improvement in survival. The development of oral fluoropyrimidines, mimicking continuous infusion 5-FU, is convenient. In randomized trials, capecitabine was equally effective to bolus 5-FU and LV in the management of metastatic CRC. CONCLUSIONS: Recently completed or ongoing clinical trials to study novel targeting agents have initiated a new era of drug development. Anti-angiogenesis drugs, tyrosine kinase inhibitors, and epidermal growth factor blockers are among this new generation of agents with encouraging preliminary data. Randomized trials will determine the impact of these newer agents on survival and quality of life of patients with metastatic CRC.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/análogos & derivados , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Camptotecina/administración & dosificación , Fluorouracilo/administración & dosificación , Humanos , Infusiones Intravenosas , Irinotecán , Leucovorina/administración & dosificación , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Pronóstico , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Supervivencia

RESUMEN

Non-small-cell lung cancer is the leading cause of cancer-related deaths in the United States. Chemotherapy has been shown to improve survival and quality of life in patients with advanced disease when compared to best supportive care. Of the commonly used therapies, platinum in combination with gemcitabine, taxanes, and vinorelbine offers superior activity to single-agent platinum or older platinum combinations. In addition, single-agent gemcitabine or single-agent paclitaxel has resulted in lower survival compared to each in combination with carboplatin in 2 recently reported phase III trials. However, among themselves new doublets have shown no improvement in survival, and treatment has traditionally been chosen based on convenience and toxicity rather than efficacy. The combination of gemcitabine and irinotecan has demonstrated promising results in preclinical studies. In this review, the data available on the combination of gemcitabine and irinotecan in phase I and phase II trials are discussed.