Colon and Rectal Cancers - Staging

Chemotherapy

Chemotherapy Drugs and Regimens

Seven drugs are currently approved for colorectal cancer chemotherapy:

• 5-fluorouracil (5-FU, Adrucil), which is often given in combination with leucovorin (Wellcovorin). Leucovorin is a vitamin that helps boost the effectiveness of 5-FU.
• Capecitabine (Xeloda)
• Oxaliplatin (Eloxatin)
• Irinotecan (Camptosar)
• Bevacizumab (Avastin)
• Cetuximab (Erbitux)
• Panitumumab (Vectibix)

Capecitabine is a pill form of 5-FU. The other drugs are administered intravenously. Many of these drugs are given in combination with each other. Common chemotherapy combination regimens include:

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• 5-FU / LV (5-FU and leucovorin)
• FOLFOX (5-FU with leucovorin and oxaliplatin)
• FOLFORI (5-FU with leucovorin and irinotecan)
• IFL (Irinotecan, 5-FU, leucovorin)
• XELOX (Capecitabine and oxaliplatin)

Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment. Because cancer cells grow and divide rapidly, chemotherapy drugs work by killing fast-growing cells. This means that healthy cells that multiply quickly can also be affected. The fast-growing normal cells most likely to be affected are blood cells forming in the bone marrow, and cells in the digestive tract, reproductive system, and hair follicles.

Nausea and vomiting are very common side effects, but drugs such as ondansetron (Zofran) can help provide relief. In general, side effects are nearly always temporary, and medications can help manage them.

Specific Chemotherapy Drugs

5-Fluorouracil (5-FU) with Leucovorin. Adjuvant (following surgery) chemotherapy using 5-fluorouracil, either alone or with leucovorin (5-FU/LV), is the standard treatment for patients with high-risk colon cancer (Stage III or select patients with Stage II tumors). Leucovorin, also called folinic acid, is a form of the B vitamin folic acid, which helps increase 5-FU’s effectiveness. Patients are given a series of cycles that usually continue for at least 6 months.

There are many different ways of giving 5-FU, including intravenously over several hours once a week, intravenously daily for 5 consecutive days every month, or as continuous infusion with a portable pump. The most common side effects include nausea and vomiting, diarrhea, loss of appetite, hair loss, swelling of hands and feet, rashes, and mouth sores.