Quelle stratégie en première ligne des cancers colorectaux métastatiques en 2008? Place de la chimiothérapie par 5FU seul

The superiority of combined chemotherapies associating fluorouracil (5FU) and oxaliplatin or irinotecan over 5FU alone in first-line treatments of patients with advanced colorectal cancer has been suggested by randomised trials. However, these trials did not take into account the fact that salvage treatments with irinotecan and oxaliplatin can confer a benefit in patients refractory to first-line 5FU-based chemotherapy. It was therefore necessary to perform strategic trials comparing sequential versus combination chemotherapy. Three trials have assessed these different strategies. They gave consistent results : combination treatment did not significantly improve overall survival compared with the sequential use of cytotoxic drugs. Thus first-line monotherapy remains a valid option for some patients. In particular for patients who can not receive a curative treatment because of co-existing diseases or incurable cancer. On the other hand, patients with potentially resectable metastases must receive a first-line chemotherapy associating two or three drugs because the main aim in this situation is to obtain the highest possible response rate in order to enable a surgical resection.