Advanced colorectal cancer, refractory to infusional fluorouracil treatment: efficacy of second line fluorouracil in combination with a different biochemical modulation

Currently there is no standard second line treatment for patients with advanced colorectal cancer (ACC). Previous reports have demonstrated that some patients may benefit from second line infusional 5-fluorouracil (5-FU) after failing 5-FU bolus treatment. We retrospectively studied the efficacy and toxicity of infusional 5FU regimens given in second line, which only differed from the first line regimen in the type of biochemical modulation and compared these results in a non-randomized fashion to the outcome of patients receiving supportive care only in second line. Sixty six patients with ACC were treated in first line with an infusional 5-FU-based schedule. At the time of disease progression 38 patients received supportive care only. The remaining 28 patients continued treatment with the same 5-FU regimen, but with another biochemical modulator. Fourteen patients achieved stable disease for a median duration of 6 months and one patient achieved a complete remission which lasted 34 months. The median survival from the time of disease progression on first line treatment was 7 months for patients who received second line treatment, whereas those who received supportive care survived for a median period of 3 months (p <0.05). Changing the type of biochemical modulation of infusional 5-FU as a second line treatment-alternative may be of some benefit to a subgroup of patients with ACC