The role of irinotecan in the treatment of colorectal cancer metastases: Surgeons and oncologists in partnership

Resection is still the gold standard treatment for operable colorectal liver metastases. However, chemotherapy is likely to play an increasingly important role in the coming years. Many patients undergoing liver resection will eventually relapse, and adjuvant chemotherapy may help to reduce the risk of relapse. Furthermore, most patients with liver metastases present with unresectable lesions, and their chances of long-term survival are low. Neoadjuvant chemotherapy can reduce the size of the lesions, in some cases enabling them to be resected, thereby prolonging patient survival. A combination of pre- and post-operative chemotherapy may have enhanced effects on improving patient outcome, and this approach is currently being assessed. Until now, fluoropyrimidines have been the mainstay of treatment for metastatic colorectal cancer. Newer drugs, such as irinotecan, show higher activity and early reports suggest benefits in the treatment of liver metastases.