Orale fluoropyrimidinen geregistreerd voor de behandeling bij gemetastaseerd colorectaal carcinoom: een mogelijke aanwinst

- Up until now the standard treatment for metastased colorectal carcinoma has been fluorouracil (5-FU) in combination with folonic acid in low doses administered intravenously, even after the recent registration of a number of new intravenously administered cytostatics, such as irinotecan and oxaliplatin.

- Meanwhile there are oral alternatives for 5-FU: capecitabine and the combination of tegafur and uracil with folonic acid. In four randomised studies it was shown that these drugs were globally just as effective as the combination of 5-FU with folonic acid (in accordance with the ‘Mayo Clinic’ scheme). There was no survival advantage for the oral drugs compared to 5-FU with folonic acid.

- Compared to 5-FU and folonic acid the use of capecitabine or tegafur-uracil-folonic acid was associated with less toxic effects; however, there were differences in the side effects profile between the oral drugs and 5-FU (more hand-foot syndrome for capecitabine and less (symptomatic) leucopenia for tegafur-uracil-folonic acid). An examination of the serious side effects (grade 3 and 4) revealed that the total incidence was generally comparable.

- These data, together with the ease of oral administration, form the basis for the registration of capecitabine and tegafur-uracil-folonic acid.

- The definitive place of these drugs in the treatment of metastased colorectal carcinoma is not yet clear.