Chemotherapy options for metastatic colorectal carcinoma: First, second, third line...

For almost 40 years, the only option for patients with unresectable metastases was treatment with 5-fluorouracil. In the last decade, new drugs became available that changed attitude toward treatment of metastatic CRC as well as the prognosis for some patients although the "story" of 5-FU is not finished yet. Irinotecan, oxaliplatin and oral fluoropyrimidines produces higher response rates, longer symptom control and longer survival for the majority of the patients with unresectable metastases. Neoadjuvant chemotherapy is particularly interesting, because according to the results of some studies, it actually allows curative resections of previously unresectable liver metastases. This paper deals with the current status of chemotherapy of metastatic CRC, and some dilemmas about that issue. Also, we report results of third line chemotherapy of metastatic CRC patients treated at the Institute for Oncology and radiology of Serbia (IORS)