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

Background: 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. Patients and methods: We retrospectively studied the efficacy and toxicity of infusional 5-FU 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. Results: 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). Conclusion: 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.