PubMed Health⌕ Search

Biomedical subjects

E Van Cutsem

Publications and source records attributed to E Van Cutsem.

At least 73 records · Page 4Linked to original sources
PubMed1999

Developments in fluoropyrimidine therapy for gastrointestinal cancer.

The combination of 5-fluorouracil and leucovorin is the standard treatment in metastatic colorectal cancer and in Dukes' C colon cancer. There is, however, no agreement on the method for administration in metastatic colorectal cancer. Several new studies published in 1998 suggest that infusional 5-fluorouracil gives a higher response rate and better toxicity profile compared with a standard bolus 5-fluorouracil/leucovorin regimen. The median survival rate, however, is not different. Several new active drugs are being developed for advanced colorectal cancer. It has not yet been shown that these drugs as single agents are superior to an optimal 5-fluorouracil regimen. Combination trials of 5-fluorouracil/leucovorin with oxaliplatin, CPT-11 and raltitrexed are ongoing, and it can be expected that several of these combinations will be more active than 5-fluorouracil/leucovorin. The challenge for the future will be to show the most active combination and the best sequence of these combinations. The development of the orally administered fluoropyrimidines was rapid in 1998. Randomized studies comparing UFT, capecitabine, and eniluracil plus 5-fluorouracil with 5-fluorouracil/leucovorin are ongoing.

Antineoplastic Agents↗
PubMed1999

Medical care consumption in a phase III trial comparing irinotecan with infusional 5-fluorouracil (5-FU) in patients with metastatic colorectal cancer after 5-FU failure.

We evaluated economic implications of treatment with irinotecan, following a RCT which demonstrated significantly increased survival at 1 year with irinotecan (45%) compared to infusional 5-fluorouracil (5-FU) (32%) in patients with metastatic colorectal cancer. Medical care consumption data were collected prospectively alongside the trial, with 256 patients followed for a median of 10 months. Follow-up was prolonged beyond treatment failure and medical care consumption was not protocol driven, enabling a realistic evaluation of economic implications. Medical care consumption associated with chemotherapy administration was lower with irinotecan as compared with infusional 5-FU. The cumulative number of days in hospital due to treatment toxicity and cancer complications, which is the key cost driver, was 14.4 (95% CI: 10.7-18.1) with irinotecan versus 17.5 (95% CI: 11.7-23.3) with infusional 5-FU. Thus, the survival benefit with second-line irinotecan compared to infusional 5-FU in patients with advanced colorectal cancer was achieved without increasing medical care consumption.

Ambulatory Care↗
PubMed1999

Additional value of whole-body positron emission tomography with fluorine-18-2-fluoro-2-deoxy-D-glucose in recurrent colorectal cancer.

PURPOSE: To assess the additional value of the whole-body [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan as a staging modality complementing conventional diagnostic methods (CDM) in patients suspected of having recurrent colorectal adenocarcinoma. PATIENTS AND METHODS: In 103 patients, the discordances between FDG-PET and CDM results were identified and related to the final diagnosis obtained by histopathology or clinical follow-up (> 1 year). All FDG-PET studies were reviewed with full knowledge of the CDM findings. RESULTS: In a region-based analysis, discordances between CDM and FDG-PET findings were found in 40 of 412 regions (10%). In these, FDG-PET had additional diagnostic value in 14 of 16 locoregional, six of seven hepatic, seven of eight abdominal, and eight of nine extra-abdominal regions. In a patient-based analysis, CDM categorized a subgroup of 60 patients as having resectable recurrent disease limited to the liver (n = 37) or locoregional region (n = 23). In 13 of these patients, there were discordant FDG-PET findings, detecting additional tumor sites in nine patients and excluding disease in three patients and yielding an additional diagnostic value in 20% of the patients. A second subgroup consisted of 13 patients with inconclusive CDM findings (n = 5) or with elevated plasma carcinoembryonic antigen levels and an otherwise negative conventional work-up (n = 8). In these patients, FDG-PET results were correct in eight of nine discordances, yielding a positive additional diagnostic value in 62% of the patients. CONCLUSION: Whole-body FDG-PET can have a clear impact on the therapeutic management in the follow-up of patients with colorectal cancer.

Abdominal Neoplasms↗
PubMed1999

Irinotecan versus infusional 5-fluorouracil: a phase III study in metastatic colorectal cancer following failure on first-line 5-fluorouracil. V302 Study Group.

In a multicenter phase III trial, 267 patients with nonbulky metastatic colorectal cancer who had failed first-line 5-fluorouracil (5-FU) therapy were randomized to receive second-line treatment with either the new topoisomerase agent, irinotecan (Rhône-Poulenc Rorer, Antony, France), or a high-dose infusional 5-FU regimen. Patients treated with irinotecan survived significantly longer than those treated with infusional 5-FU. The 1-year survival rate was 45% for patients receiving irinotecan compared with 32% for patients receiving 5-FU. There also was a significant difference in median progression-free survival (4.2 months v 2.9 months; P = .03) favoring irinotecan. Irinotecan administered at a dose of 350 mg/m2 every 3 weeks was associated with manageable toxicities (the main toxicities were neutropenia and diarrhea). The incidence of these adverse events and of vomiting was higher with irinotecan than with the comparator regimens of infusional 5-FU. However, the incidence of grade 3-4 asthenia was the same in the two treatment arms and mucositis and cutaneous adverse events were more common with 5-FU. Overall, mean global quality of life scores were similar in the two arms of the study throughout the period of treatment and follow-up, demonstrating that the more effective disease control achieved by irinotecan at least maintains quality of life. Indeed, deterioration in quality of life (defined as >50% decrease from baseline score) occurred significantly later in irinotecan-treated patients. In light of these data, irinotecan should be considered the reference treatment for patients with 5-FU-refractory advanced colorectal cancer.

Antimetabolites, Antineoplastic↗
PubMed1998

Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer.

BACKGROUND: In phase II trials, irinotecan is active in patients with advanced colorectal cancer, but the survival and clinical benefit of irinotecan compared with second-line fluorouracil by continuous infusion is not known. METHODS: 267 patients who had failed to respond to first-line fluorouracil, or whose disease had progressed after treatment with first-line fluorouracil were randomly allocated irinotecan 300-350 mg/m2 infused once every 3 weeks or fluorouracil by continuous infusion. Treatment was given until disease progression, unacceptable toxic effects, or the patient refused to continue treatment. The primary endpoint was survival, while progression-free survival, response rate, symptom-free survival, adverse events, and quality of life (QoL) were secondary endpoints. FINDINGS: 133 patients were randomly allocated irinotecan and 134 were allocated fluorouracil by continuous infusion. Patients treated with irinotecan lived for significantly longer than patients on fluorouracil (p=0.035). Survival at 1 year was increased from 32% in the fluorouracil group to 45% in the irinotecan group. Median survival was 10.8 months in the irinotecan group and 8.5 months in the fluorouracil group. Median progression-free survival was longer with irinotecan (4.2 vs 2.9 months for irinotecan vs fluorouracil, respectively; p=0.030). The median pain-free survival was 10.3 months and 8.5 months (p=0.06) for irinotecan and fluorouracil, respectively. Both treatments were equally well tolerated. QoL was similar in both groups. INTERPRETATION: Compared with fluorouracil by continuous infusion second-line irinotecan significantly improved survival in patients with advanced colorectal cancer.

Adenocarcinoma↗
PubMed1998

A phase II study of irinotecan alternated with five days bolus of 5-fluorouracil and leucovorin in first-line chemotherapy of metastatic colorectal cancer.

PURPOSE: This multicenter phase II study was designed to assess the efficacy of the alternating schedule of irinotecan (CPT-11) with bolus 5-fluorouracil (5-FU) and leucovorin (LV) in first-line chemotherapy for metastatic colorectal cancer (CRC). PATIENTS AND METHODS: Patients with histologically proven metastatic colorectal cancer, and at least one bidimensionally measurable lesion, aged 18-70, with performance status < or = 2, normal baseline biological values and no prior chemotherapy (or only adjuvant chemotherapy completed > or = 6 months before study entry) were selected. Treatment was irinotecan 350 mg/m2, i.v., day 1, alternating with leucovorin 20 mg/m2 i.v. and 5-FU 425 mg/m2, i.v. daily for five consecutive days, day 22-26 (Mayo Clinic regimen). One alternating cycle was to be performed every six weeks. Patients were evaluated for efficacy every alternating cycle. Treatment was administered until five alternating cycles, disease progression, unacceptable toxicity or patient refusal. RESULTS: Thirty-three patients (28 chemotherapy-naïve and five with prior adjuvant treatment completed > 1 year prior to accrual) were enrolled. The objective response rate (RR) was 30% (95% CI: 16-49; 10 patients/33; nine partial response and one complete response). All responses were reviewed by an independent external review committee. An additional 49% of patients had stable disease. The median survival was 16 months, the one year survival amounted to 58% and the median progression free survival was 7.2 months. Relative dose intensity was nearly 90% for both drugs. Grade 3-4 diarrhea and neutropenia were the most frequent severe toxic events, seen in 24% and 64% of patients, respectively. CONCLUSIONS: The alternating schedule of CPT-11 350 mg/m2 with five days bolus of 5-FU and low dose LV is an active and feasible regimen as front-line therapy for metastatic CRC. It is well tolerated, without evidence of overlapping toxicity. The response rate appears promising with regard to that expected with either single agent. This regimen warrants further assessment in randomized trials.

Adult↗
PubMed1998

Intestinal metaplasia in gastric malignancy: a comparison between carcinoma and lymphoma.

OBJECTIVES: Intestinal metaplasia is associated with gastric carcinomas, in particular intestinal-type carcinomas. According to the literature, intestinal metaplasia, especially the sulphomucin-rich incomplete type (type IIb or III) can be considered as a precancerous lesion. Intestinal metaplasia is not uncommon in gastric lymphomas, and the purpose of this study was to determine its prevalence and extent, its different subtypes and the distribution of sulphomucin and to compare these findings with those in gastric carcinomas. DESIGN: The prevalence and grade of intestinal metaplasia were investigated in surgical specimens from 160 patients with gastric carcinoma (102) [intestinal type (69), diffuse type (33)] and gastric lymphoma (58) [marginal zone cell (29), diffuse large cell (29)]. Intestinal metaplasia is analysed by specific mucin stains. METHODS: Intestinal metaplasia was described according to the Updated Sydney system. Using periodic acid-Schiff Alcian Blue pH 2.5 and high iron-diamine/Alcian Blue staining, the intestinal metaplasia was classified (Jass classification) and its sulphomucin content was determined. RESULTS: The prevalence and extent of intestinal metaplasia are significantly higher in intestinal-type carcinomas than all other gastric malignancies. Subtyping of intestinal metaplasia is independent of the different types of gastric neoplasia. High sulphomucin positivity in the metaplastic epithelium is only seen in intestinal-type carcinomas, although in a small number of cases (21.5%). CONCLUSION: Prevalence, extent and sulphomucin content of intestinal metaplasia are significantly higher in intestinal-type gastric carcinoma compared to diffuse-type carcinoma, marginal zone cell and diffuse large cell lymphomas in the stomach.

Adenocarcinoma↗
PubMed1998

Primary liver tumour of intermediate (hepatocyte-bile duct cell) phenotype: a progenitor cell tumour?

A 57-year-old female patient presented with painless obstructive jaundice and mild mesogastric pain; she was in good general condition on admission. Abdominal ultrasonography revealed diffuse tumoral invasion of the liver, suggesting diffuse metastases. A liver biopsy showed a tumour with a trabecular growth pattern, composed of uniform relatively small cells, very suggestive of an endocrine carcinoma. Additional immunohistochemical stains, however, did not show any endocrine differentiation, but showed positivity for both hepatocyte-type cytokeratins (cytokeratin 8 and 18) and bile duct-type cytokeratins (cytokeratin 7 and 19). In addition, parathyroid hormone-related peptide, shown to be a good marker for cholangiocarcinoma, was immunoreactive. Electron microscopy revealed tumour cells with an intermediate phenotype: the cells clearly showed hepatocyte features on one hand and bile duct cell features on the other hand. Nine days after admission, the patient died due to liver failure and hepatic encephalopathy. Autopsy excluded another primary tumour site. Overall, this tumour was a primary liver tumour with an intermediate phenotype and with a very rapid clinical course. The intermediate (between hepatocyte and bile duct cell) phenotype suggests an immature progenitor cell origin, which is concordant with a rapid clinical course. This type of tumour has not been described previously and provides additional evidence for the existence of progenitor cells in human liver.

Bile Ducts↗
PubMed1998

Ambulatory gastrojejunal manometry in severe motility-like dyspepsia: lack of correlation between dysmotility, symptoms, and gastric emptying.

BACKGROUND: Previous studies have failed to identify manometric patterns of gastrointestinal motor activity that can distinguish dyspepsia from health. AIMS: To test the hypothesis that the combined use of prolonged, ambulatory, antrojejunal manometry and computer aided analysis in patients selected for the severity of their symptoms could reveal new insights into gastrointestinal motor activity in patients with severe motility-like dyspesia. METHODS: Twenty four hour antrojejunal ambulatory manometry was performed in 14 patients and 10 healthy volunteers. Parameters characterising digestive and fasted motility were obtained by a validated computer program and visual analysis. Scoring systems quantified the degree of dysmotility as well as the severity of symptoms. Gastric emptying times were measured in each patient. RESULTS: There was a high prevalence of antral and jejunal dysmotility both during the interdigestive period (71% of patients) and in the postprandial period (78%). During the interdigestive period there was a reduced incidence of antral and jejunal phases, a larger contribution of phase 2 during migrating motor complex cycles, and aberrant configuration of jejunal phase 3 in 29% of patients. Postprandially, the most frequent finding was antral (29% of patients) or jejunal (29%) hypomotility or hypermotility. Minute rhythm was present both during the postprandial (29% of patients) and the interdigestive period (21%). There was no positive correlation between symptom scores, gastric half emptying times, or motility scores. CONCLUSION: Even with the use of prolonged recordings and advanced computer aided analysis, it is not possible to identify a specific motor pattern which can discriminate patients with severe motility-like dyspepsia from those with other diseases or even healthy individuals. Clinical symptoms or gastric half emptying times are poor predictors of gastrointestinal dysmotility in patients with functional dyspepsia.

Adolescent↗
PubMed1998

Open, randomized, multicenter trial of raltitrexed versus fluorouracil plus high-dose leucovorin in patients with advanced colorectal cancer. Tomudex Colorectal Cancer Study Group.

PURPOSE: To compare raltitrexed (Tomudex; Zeneca Pharmaceuticals Ltd, Macclesfield, United Kingdom) a direct, specific thymidylate synthase (TS) inhibitor with fluorouracil (5-FU) plus high-dose leucovorin (LV) as first-line treatment for advanced colorectal cancer (ACC). PATIENTS AND METHODS: A total of 495 patients were randomized to raltitrexed (3 mg/m2) once every 3 weeks or 5-FU (400 mg/m2) plus LV (200 mg/m2) daily for 5 days every 4 weeks. RESULTS: The randomized groups were well balanced demographically. With a minimum 17-month follow-up, median survival was comparable between groups (10.9 months raltitrexed v 12.3 months 5-FU/LV; hazards ratio, 1.15; 95% confidence interval [CI], 0.93 to 1.42; P=.197), although time to progression was statistically significantly shorter in the raltitrexed group. Overall objective responses were comparable (19% raltitrexed v 18% 5-FU/LV), with more than 50% of patients in each group having stable disease. Significantly less World Health Organization (WHO) grade 3 and 4 stomatitis (2% v 16%, P < .001) and a reduced incidence of leukopenia (6% v 13%) and diarrhea (10% v 19%) occurred in the raltitrexed group (particularly at cycle 1 ). This resulted in fewer dose reductions at cycle 2 (4% raltitrexed v 28% 5-FU/LV) and early quality-of-life (QoL) benefits for raltitrexed patients. Reversible, clinically insignificant increases in transaminases were reported in 13% of raltitrexed patients. Palliative benefits of weight gain, improved performance status, and reduced disease-related symptoms were evident in both groups. CONCLUSION: Raltitrexed is confirmed as an effective option in the first-line palliative management of ACC, with comparable efficacy to and tolerability advantages (in terms of reduced incidence of stomatitis, diarrhea, and leukopenia) over 5-FU/LV. Raltitrexed has the added convenience of an every 3 weeks dosing schedule.

Adenocarcinoma↗
PubMed1998

Raltitrexed (Tomudex).

Raltitrexed (Tomudex) is a new specific, mixed non-competitive inhibitor of thymidylate synthase indicated for use in the therapy of advanced colorectal cancer. Phase I and II studies defined a maximum tolerated dose of 3.0 mg/m(2) administered as a 15-min i.v. infusion every 3 weeks: this dose proved active in a range of malignancies, but most significantly in advanced colorectal cancer. Phase III studies in patients with advanced colorectal cancer indicate similar efficacy with raltitrexed monotherapy and combination therapy with 5-fluorouracil + low or high dose leucovorin (5-FU + LV) (Mayo or Machover regimens, respectively). Major toxicity in the various studies of raltitrexed included gastrointestinal effects, haematological suppression, asthenia and reversible asymptomatic increases in hepatic transaminases. However, patients receiving 5-FU + LV experienced more severe leucopaenia and mucositis than patients receiving raltitrexed: this translated into fewer toxicity-related dosage reductions. Raltitrexed is therefore as effective as but better tolerated and accepted than 5-FU + LV. Thus, raltitrexed offers the first alternative to 5-FU-based therapy in advanced colorectal cancer; furthermore, the mode of action of the drug offers the potential for synergy with agents that act via other molecular mechanisms.

Journal Article↗
PubMed1998

[Irinotecan monotherapy in the treatment of colorectal cancers: results of phase II trials].

Irinotecan or CPT11 is a topoisomerase 1 inhibitor. The European and American regimens of irinotecan in monotherapy are different: respectively 350 mg/m2 i.v. every 3 weeks and 125 mg/m2 i.v. weekly (4 weeks out of 6). In a large phase 2 programme an important activity has been shown in metastatic colorectal cancer. In 5FU resistant colorectal cancer an objective response rate of 13% has been shown. This was associated with a long median time of response, a long median time to progression and a long median survival. More than 40% of patients had also a stabilisation in second line treatment. This interesting activity was the basis for the phase 3 studies that have positioned irinotecan as the standard treatment in 5FU resistant colorectal cancer. The response rate in first line treatment of colorectal cancer varies between 18% and 32%. The main side effects are neutropenia and delayed diarrhea.

Adenocarcinoma↗
PubMed1997

Surgery for gastric remnant carcinoma following Billroth II gastrectomy.

Between January 1983 and December 1995, 31 patients with gastric remnant carcinoma were operated on 6-45 years after a Billroth II resection for peptic ulcer disease. Total gastrectomy with Roux-en-Y reconstruction was performed in all cases. In 16 patients (52%) extended resection with removal of one or more adjacent organs was necessary for oncological reasons. In this elderly population with a high incidence of pre-operative risk factors (55%), most tumours were classified as stage III or IV (45%). Although total gastrectomy should be the surgical option of first choice for gastric remnant carcinoma, it resulted in high levels of post-operative mortality and morbidity (13% and 35%, respectively), especially in patients with stage III and IV tumours who underwent resection of an adjacent organ. Despite extended surgery, if necessary, the recurrence rate after 'curative' surgery is high (8/20 patients) and the cumulative disease-free 5-year survival rate was 48%. Detection of the tumour at an earlier stage not only limits the extent of resection and lowers the complication rate, but also improves survival.

Aged↗
PubMed1997

Induction therapy for clinical T4 oesophageal carcinoma; a plea for continued surgical exploration.

OBJECTIVE: Complete resection of a locally advanced oesophageal carcinoma is not always feasible when invading mediastinal structures. The use of induction therapy prior to surgical exploration in patients with these clinical T4 tumours is anticipated to improve the resectability rate. METHODS: Patients, 18, who presented with a carcinoma of the thoracic oesophagus with clinical invasion into the carina (n = 6), trachea (n = 5), aorta (n = 4), lung (n = 2) and diaphragm (n = 1) were treated with concurrent chemotherapy and radiotherapy followed by surgical exploration. Follow-up was complete (mean of 17 +/- 3 months in all patients and 27 +/- 2 months in surviving patients). RESULTS: All patients completed the induction therapy with acceptable toxicity and no mortality. Subjective improvement in dysphagia was substantial in 11 patients (in 8/11 patients (73%) however, there was still viable tumour in the resected specimen), it was minimal in six patients and absent in one patient. Objective response on imaging was complete in one patient, partial in eight patients and minimal in nine patients [in two of these nine patients (22%) nevertheless, the primary tumour had disappeared completely in the resected specimen (pT0)]. Resection was complete (R0) in 14 patients (78%) and incomplete (R1) in one patient (5%). Resection of the primary tumour was impossible (R2) in three patients (17%) because of macroscopic airway (n = 2) and hilar (n = 1) invasion on exploration. In these three patients the tumour was bypassed using a retrosternal split stomach. One patient was proven at the time of surgery to have a previously unidentified lung metastasis. In three patients (17%), no residual tumour cells were found in the resected oesophagus nor in the lymph nodes (pT0N0M0). There have been no in-hospital deaths. Actuarial 3 year survival was 43% in all patients, 55% in completely resected patients and 100% in sterilized patients (pT0N0M0). Median survival was 18 months in all patients. CONCLUSIONS: Chemo/radiotherapy followed by surgery in patients with a clinical T4 oesophageal carcinoma is feasible with acceptable toxicity and no treatment-related mortality. Operability and resectability rate were high (100 and 83%, respectively) compared with historical controls. The primary tumour disappeared completely (pT0N0-1M0-1) in 28%. Tumour sterilization rate was 17%. Survival looks promising compared with historical controls. Subjective neither objective response following induction therapy clearly correlated with the final pTNM staging. This indicates that, in the absence of tumour progression, neither the patient nor the treating physician should jeopardize the chance for ultimate cure by denying surgical exploration following induction therapy.

Actuarial Analysis↗
PubMed1997

Future developments with 'Tomudex' (raltitrexed).

The efficacy and tolerability of raltitrexed ('Tomudex', formerly ZD1694) as a single agent for the treatment of advanced colorectal cancer has been established in a large clinical trial programme. It is now possible to move the drug forward into the treatment of earlier stages of colorectal cancer. In addition, its mode of action lends itself to combination with other agents, not only 5-fluorouracil, but also oxaliplatin and irinotecan for the treatment of advanced disease. Preclinical and early clinical data also suggest that raltitrexed may show activity in a range of other tumour types. Studies evaluating these potential clinical applications of raltitrexed are either planned or already under way.

Animals↗
PubMed1997

Size quantification of liver metastases in patients undergoing cancer treatment: reproducibility of one-, two-, and three-dimensional measurements determined with spiral CT.

PURPOSE: To assess the reproducibility of one-, two-, and three-dimensional measurements of the size of liver metastases. MATERIALS AND METHODS: The sizes of 10 liver metastases were determined 200 times: Ten observers measured each lesion by using images obtained at two different CT studies and with five different measurement techniques (maximum diameter, product of diameters, area, volume, and product of three diameters). They repeated each measurement in a separate session. The influence of measurement technique and lesion type (size and morphologic appearance) on measurement reproducibility was assessed. RESULTS: Three-dimensional measurements proved to be as reproducible as one- and two-dimensional measurements. Measurement reproducibility was influenced mainly by the size (P < .0001) and morphologic appearance (P < .01) of the lesions. CONCLUSION: Three-dimensional size measurements obtained with spiral CT are reproducible and could therefore replace the two-dimensional measurements of tumor size currently obtained with follow-up CT studies.

Humans↗
PubMed1996

A glimpse of the future. new directions in the treatment of colorectal cancer.

This paper overviews new directions in colorectal cancer therapy, focusing on adjuvant therapy, new cytotoxic agents and novel approaches. Reduced mortality with adjuvant therapy is mainly achieved in resectable colorectal cancer, using regimens of 5-fluorouracil (5-FU) plus leucovorin, 5-FU plus levamisole and 5-FU plus radiation. Not all patients are suitable for adjuvant therapy, and a better definition of prognostic factors will improve selection of patients for therapy. Several thymidylate synthase inhibitors are in development, including 'Tomudex' (raltitrexed, previously known as ZD1694), which has reached phase III studies, LY 231514, AG 331, AG 337, BW 1843 U89 and ZD 9331. Topoisomerase I inhibitors (e.g. CPT II, topotecan), ethynyluracil, oxaliplatin and 5-FU prodrugs are also promising therapeutic agents. Novel approaches include angiogenesis inhibitors, drugs which can stimulate apoptosis, generation of cytotoxic drugs from non-toxic prodrugs at tumour sites and conjugation of anti-tumour agents to polymeric carriers. Various modalities of specific and non-specific immunotherapy are also under research. These advancements promise improvements in the prognosis of colorectal cancer patients.

Antineoplastic Agents↗