The chemotherapy of metastatic @entity14 ( @entity14 ) has undergone a succession of refinements. Through the biochemical modulation of @entity1487 ( @entity1487 ) with @entity4181 (FA), the use of infusional rather than bolus regimens and the combination of @entity1487 /FA with other active agents (notably @entity2600 ), first-line response rates (RRs) of 40% can be achieved, with @entity1 surviving up to 17 months. Significant benefits on survival are also seen with second-line chemotherapy. The question of how best to sequence combination chemotherapy was addressed in a recent trial in which @entity1 were randomized to receive either an @entity2600 -based combination with @entity1487 /FA (FOLFIRI) followed by an @entity901 -based combination (FOLFOX), or the two regimens in the reverse order. In both arms, RRs were greater than 50% and median survival exceeded 20 months. The primary end point was time to progression after two lines of treatment, and this was not significantly different. However, the sequence FOLFIRI followed by FOLFOX appears preferable because of the better tolerability of FOLFIRI in first-line use. Use of the sequence FOLFIRI/FOLFOX is also supported by the greater chance of a second-line response with FOLFOX. Concern has been expressed about the safety of @entity2600 combined with bolus @entity1487 /FA. Infusional regimens have a better risk/benefit ratio than bolus regimens. However, the adverse event profile with both approaches is manageable, and @entity2600 plus @entity1487 /FA can be considered one standard of care in metastatic @entity14 .

Metastatic XXXX : integrating @entity2600 into combination and sequential chemotherapy.

@entity4181 :: ('MESH:D002955', 'Chemical') :: ['folinic acid'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity901 :: ('MESH:C030110', 'Chemical') :: ['oxaliplatin'] @entity2600 :: ('MESH:C051890', 'Chemical') :: ['irinotecan'] @entity14 :: ('MESH:D015179', 'Disease') :: ['CRC', 'colorectal cancer'] @entity1487 :: ('MESH:D005472', 'Chemical') :: ['5-FU', '5-fluorouracil']
@entity14 :: (MESH:D015179,Disease) :: ['colorectal cancer']
