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Colorectal Cancer Health Center

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Colorectal Cancer: New Treatments, Improved Prognosis

New drugs show promise, but more research needs to be done.

Fine-Tuning Chemotherapy for Colorectal Cancer

With more drugs to use for colorectal cancer, doctors are now trying them in new combinations and sequences.

Experts have developed a number of regimens that combine the benefits of different drugs. For some time, IFL or the "Saltz Regimen" (Irinotecan, 5-Fluorouracil and Leucovorin) was a primary treatment. But new regimens have eclipsed it, Hoff tells WebMD.

"IFL has largely been abandoned in the U.S.," says Hoff, "It's considered a little more toxic and less effective than FOLFOX (Folinic Acid, Fluorouracil, Leucovorin, and Oxaliplatin) and FOLFIRI ( Folic Acid, Leucovorin, Fluorouracil, and Irinotecan)."

In people with metastatic cancer, these regimens may be combined with Avastin or Erbitux. Many other combinations, including the use of Avastin and Erbitux at the same time, are being tested in clinical trials.

Researchers are also studying whether Avastin and Erbitux could be used in earlier stages of the disease, when the chances of actually curing the cancer are much higher. However, the results of those trials are a ways off, says Hoff.

A Dramatic Rise in Costs

The key problem with the new targeted therapies is their price.

"Avastin and Erbitux are outrageously expensive," says Anthony Back, MD, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle.

The numbers show an explosion in the cost of treating colorectal cancer because of these drugs. One year's worth of treatment with the combination of Erbitux and Camptosar for metastatic colon cancer would add up to $161,000, according to an article published in the New England Journal of Medicine in 2004. Overall, the article noted that the costs for the first eight weeks of standard treatment for advanced colorectal cancer have risen 340 times over the past 10 years.

For people with insurance that covers medication, the actual costs may seem irrelevant. But even the co-payments for these drugs add up.

"Some people have 20% co-pays for these medications," says Back. "Over the course of therapy for metastatic cancer, that adds up to tens of thousands of dollars out of their own pockets." The high cost of drugs could force a person to make the impossible choice between extra months of life and financial ruin for his or her family.

"The benefits of these drugs are so dramatic that we can't deny people from getting them," says Damian Augustyn, MD, spokesperson for the American Gastroenterological Association. "But the costs will put an enormous strain on the health care system."

Saltz agrees. "It doesn't take an economist to see that these prices are unsustainable," he tells WebMD.

Although your insurance company may bear the brunt of these costs now, experts worry that even insured patients may be affected eventually. As the drugs become more widely used, their price tag could make insurance companies attempt to limit their use.

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