Stage IV Chemotherapy

Chemotherapy is the cornerstone of treatment for metastatic (Stage IV) colorectal cancer.  Recent advancements in therapy and personalized genetic tests have significantly improved survival of patients with stage IV disease.  In addition, promising new therapies and combinations of chemotherapy with targeted agents are being tested in clinical trials for all stages of colorectal cancer and particularly in stage IV.

For newly diagnosed patients that have never been treated with chemotherapy, the current standard of care is a combination of therapies that are typically delivered intravenously.  These combinations are composed of three to four different drugs, as follows:

5FU Oxaliplatin Leucovorin and is called FOLFOX 


5FU Irinotecan Leucovorin and is called FOLFIRI

FOLFIRI and FOLFOX can be used with another therapeutic named Avastin, which appears to improve the benefit from both of these combinations.  The decision to use FOLFOX or FOLFIRI is up to your Oncologist and is based several factors.  Addition or exclusion of Avastin is also decided on a patient-to-patient basis. 

Clinical researchers are constantly trying to improve the treatment of stage IV colon cancer. Most recently, addition of an antibody that blocks the binding or a growth factor has shown promise in a subset of colorectal cancer patients.  Two antibodies exist (Vectibix and Erbitux) and have been shown to work only in patients without a mutation in a cancer gene called KRAS.  This can be tested in tumor tissue used to make your diagnosis or removed during surgery. 

Other newer combinations are being tested in clinical trials at our institution and throughout the world.  We support all efforts to improve the treatment of patients with metastatic (stage IV) colorectal cancer.  It is everyone’s hope that as more clinical trials are completed better therapies will emerge. 

These different therapies can be used alone or in combination if needed.  This will be determined by your Oncologist and will be based on how your cancer has responded to therapy.