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According to recent results reported in the Annals of Oncology, the chemotherapy combination oxaliplatin and raltitrexed (Tomudex®)appears to be effective treatment in metastatic colorectal cancer.

Colorectal cancer affects the colon and rectum, parts of the body's digestive system that together form a long, muscular tube called the large intestine. The colon consists of the first 6 feet of the large intestine and the rectum is the last 8-10 inches. Colorectal cancer is the second leading cause of cancer mortality in the United States and Europe, and accounts for 15% of new cancer cases each year. Metastatic, or stage IV, colorectal cancer refers to cancer that has spread from its site of origin to distant sites in the body. Currently, the standard chemotherapy regimen for patients with stage IV colorectal cancer is Camptosar® (irinotecan or CPT-11), 5-FU and leucovorin (LV). The chemotherapy combination oxaliplatin/5-FU/LV, however, has demonstrated improved responses compared to the standard regimen and is awaiting approval in the United States. Since most patients with advanced colorectal cancer are not considered curable, researchers continue to evaluate novel therapeutic regimens or chemotherapy combinations for the treatment of this disease in order to improve survival.

Researchers from Italy recently conducted a clinical trial evaluating the chemotherapy combination referred to as TOMOX, which includes raltitrexed, not yet approved in the United States, plus oxaliplatin for the treatment of metastatic colorectal cancer. The trial involved 58 patients who had not received prior therapy. The overall anti-cancer response rate was 50%, with 3 patients achieving a complete disappearance of cancer and 26 patients achieving a partial disappearance of cancer. At the time of publication of this study, 44 patients were still alive. The average time to cancer progression following therapy was 6.5 months. Neutropenia (low white blood cell levels) and reversible elevated liver enzymes were the most common side effects. There were no treatment-related deaths.

These researchers concluded that raltitrexed plus oxaliplatin produces significant anti-cancer activity and is well tolerated for the treatment of metastatic colorectal cancer. Future clinical trials directly comparing raltitrexed and oxaliplatin to other commonly used chemotherapy combinations in colorectal cancer are warranted. Patients with metastatic colorectal cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating raltitrexed plus oxaliplatin or other promising therapies. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients.

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Reference: Cascinu S, Graziano F, Ferraù F, et al. Raltitrexed plus oxaliplatin (TOMOX) as first-line chemotherapy for metastatic colorectal cancer. A phase II study of the Italian Group for the Study of Gastrointestinal Tract Carcinomas (GISCAD).

Annals of Oncology. 2002;13:716-720.

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