The incidence and age-adjusted mortality of colorectal cancer (CRC) has drastically increased in the past 2 decades in Taiwan. Fortunately, chemotherapy for metastatic CRC also showed improvement in terms of tumor response rate and survival in the corresponding time period. For its low toxicity profile and high objective response rate (17.5%-31.9% in patients who received low-dose 5-fluorouracil [5-FU] that failed and 53.3%-61.5% in patients who were chemotherapy-naive), weekly 24-hour infusion of high-dose 5-FU and leucovorin (LV) has been a favorable regimen for advanced CRC for medical oncologists in Taiwan. Investigators also put their effort in exploring the mechanisms of high efficacy and low toxicity profile of this regimen, as well as the prognostic factors in predicting tumor response to this regimen. With the emergence of new, active compounds for metastatic CRC, a simple 2-hour infusion of oxaliplatin plus 46-hour infusion of 5-FU/LV every 2 weeks has become a favorable regimen, with an overall response rate (ORR) of 40%-50% and overall survival of 18.2 months in chemotherapy-naive patients. Conversely, there were also studies to suggest that biweekly oxaliplatin plus weekly or biweekly bolus 5-FU/LV was shown to achieve a comparable tumor response and survival in 5-FU-refractory metastatic CRC. In patients who had been treated with oxaliplatin plus infusional 5-FU/LV that failed, salvage biweekly irinotecan plus bolus and infusional 5-FU/LV could achieve an ORR of 22.2% with a median duration of response of 8 months. As for oral fluoropyrimidine analogues, oral tegafur/uracil and capecitabine are available in Taiwan. In addition, a clinical trial of dendritic cell-based immunotherapy for chemotherapy-refractory metastatic CRC has also been initiated and is in progress.
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