A comparison of XELOX with FOLFOX-4 as first-line treatment for metastatic colorectal cancer

Oral capecitabine has been shown to be a convenient and well tolerated alternative to intravenous 5-fluorouracil (5-FU) in the treatment of colorectal cancer. The question of whether capecitabine is an adequate and equally effective substitute for infusional 5-FU in combination with oxaliplatin for the treatment of advanced colorectal cancer has long been unanswered. On the basis of results from the randomized, phase III trial by Cassidy et al., capecitabine in combination with oxaliplatin has emerged as a valid treatment alternative to infusional 5-FU in combination with oxaliplatin in patients with advanced colorectal cancer. For patients treated in the US, however, questions about the most appropriate dosage and schedule of capecitabine have not yet been completely resolved. Oncologists will probably have to use a lower starting dose of capecitabine in combination therapies that include oxaliplatin, than that used in this study.