In patients with advanced colorectal cancer, chemotherapy
is
delivered with palliative rather than curative intent.
For over
four decades fluorouracil has been the mainstay of treatment
for advanced colorectal cancer. Folinic acid is given
intravenously before fluorouracil to enhance the fluorouracil’s
cytotoxicity. Large randomised trials of chemotherapy
versus
best supportive care have shown that fluorouracil based
chemotherapy adds about 4-6 months to the remaining life
of
patients with advanced colorectal cancer. Chemotherapy
delays
the occurrence or progression of symptoms by about six
months and improves symptoms, weight gain, and functional
performance in about 40% of patients. Palliative chemotherapy
in advanced colorectal cancer should not be restricted
by
chronological age but by fitness and activity level.
Chemotherapy for advanced colorectal cancer should be
prescribed by experienced oncologists familiar with the
toxicity
profile of the drug regimens used. Despite concerns over
toxicity, currently used infusional regimens are remarkably
well
tolerated. Management of toxicities in the community
requires
close liaison with the hospital team, and severe toxicity
requires
immediate admission. The most common effects of toxicity
from chemotherapies for advanced colorectal cancer are
diarrhoea, mucositis, asthenia, and neutropenia. Nausea,
alopecia, and anorexia can also be experienced. Diarrhoea
can
be substantially relieved with oral antimotility drugs.
Mucositis
should be managed with antiseptic mouthwash and
prophylactic or early treatment of oral candidiasis.
Neutropenia
is less common with current infusional regimens but must
always be suspected in patients with fever. Prolonged
treatment
with fluorouracil can produce painful blistering erythema
of
palms and soles of the feet (palmar plantar
erythrodysaesthesia), which often improves with pyridoxine.
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