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Efficacy and Toxicity in Colorectal Cancer: 5-Fluorouracil versus Capecitabine

April-June 2017, Volume 12, Number 2
Gloria Marquina, P. Peinado, A. Díaz-Serrano and J. Sastre
Oncology Department, Hospital Clínico San Carlos, Madrid, Spain

Fluoropyrimidines play a key role in the treatment of colorectal cancer in any scenario of the disease: adjuvant treatment, neoadjuvant treatment, and in metastatic colorectal cancer. Historically, 5-fluorouracil, an intravenous drug, has been tested in different schedules in monotherapy and in combination with a bio-modulator, leucovorin, achieving a significant improvement in patient outcomes. The survival outcomes were improved introducing the infusional schedule. Since the development of an oral fluoropyrimidine, capecitabine, several studies were designed to compare the efficacy and toxicity profile between 5-fluorouracil and capecitabine in monotherapy or in combination with other drugs such as oxaliplatin or irinotecan. In this article we will review the main differences between the formulation of both of the drugs (capecitabine and 5-fluorouracil) as well as their mechanism of action, we will review the comparative studies in monotherapy in colorectal cancer addressing the main differences in activity and toxicity and, finally, we will review the comparative studies in combination with oxaliplatin, irinotecan, and targeted therapies.

Key words:
Fluoropyrimidine. Capecitabine. 5-fluorouracil. Colorectal cancer. Oxaliplatin. Irinotecan. Bevacizumab. Cetuximab. Elderly. Adjuvant.
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