Some patients with advanced colorectal cancer may be able to receive a kinder and gentler form of treatment without compromising their overall likelihood of survival.
Researchers from both England and the Netherlands found a sequential form of chemotherapy, which begins with just one drug and progresses to other drugs, had no measurable effect on survival when compared with combination drug therapy from the outset.
The two studies were conducted among people with incurable, advanced forms of the disease. These patients have typically been treated aggressively with a combination of chemotherapy drugs. Combination therapy, however, causes many more unwanted side effects than treatment with a single drug.
So, will sequential drug treatment become the standard for these patients? Not so fast, write investigators from the Mayo Clinic in Rochester, Minn., and Martin-Luther University in Germany. In a comment on the study, the authors report must be developed first to identify patients most likely to benefit from the new strategy and, just as importantly, which patients would benefit from the traditional approach.
They write, “Until then, to maximize the potential benefit for each patient, an approach based on prognosis and disease presentation with initial combination chemotherapy for most patients, reserving single-agent fluorouracil for patients with less aggressive or never-resectable disease, should be the standard of care for first-line treatment of metastatic colorectal cancer.”
Despite proven methods to screen for and prevent colorectal cancer, about one million people around the world are diagnosed with the disease every year. About 45 percent have the advanced form of the condition requiring treatment with chemotherapy.
SOURCE: The Lancet, published online July 12, 2007
