ABC of colorectal cancer : treatment of advanced disease

Current chemotherapy regimens used in advanced colorectal cancer (ACRC) are similar in terms of efficacy, but differ importantly in terms of side‐effects and administration profiles. These differences may impact significantly on patients’ lives. We have evaluated patient preferences between raltitrexed (‘Tomudex’) and 5‐fluorouracil‐based chemotherapy regimens, with regard to side‐effect attributes (raltitrexed and Mayo regimens) and administration attributes (raltitrexed, Mayo, De Gramont and Lokich regimens) in a study based on 82 patients with ACRC. Patients completed a series of rating tasks on how ‘upsetting’ these attributes were to them using a visual analogue scale (VAS) in a structured interview conducted by a research nurse. Mucositis and asthenia were the most and least upsetting side‐effects, respectively. The side‐effect profile of raltitrexed was clearly preferred by 78% of patients versus 14% for Mayo (P < 0.001). When side‐effects and administration attributes were combined into an overall profile, 91% of patients selected raltitrexed as their clearly preferred regimen, versus 6% for Mayo (P < 0.001). The administration regimen of raltitrexed was ranked most acceptable (mean rank score 1.5 compared with Mayo 2.6, De Gramont 2.7, and Lokich 3.3). Given similar palliative effects, patients with ACRC exhibit preferences for raltitrexed over other regimens, based on administration and/or side‐effect attributes. Such preferences should constitute an important part of decisions relating to the choice of chemotherapy regimen in ACRC