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This combination therapy represents the standard-of-care chemotherapy regimens—specifically LV5FU2 (5-fluorouracil and folinic acid), FOLFOX (5-fluorouracil, folinic acid, and oxaliplatin), and FOLFIRI (5-fluorouracil, folinic acid, and irinotecan)—utilized as the chemotherapy backbone in clinical trials for metastatic colorectal adenocarcinoma. These regimens work through multiple cytotoxic mechanisms: 5-fluorouracil acts as an antimetabolite by inhibiting thymidylate synthase to disrupt DNA synthesis; folinic acid (leucovorin) acts as a biochemical modulator to enhance the binding and efficacy of 5-fluorouracil; oxaliplatin is a platinum-based agent that forms DNA cross-links to inhibit replication; and irinotecan is a topoisomerase I inhibitor that prevents DNA religation, leading to double-strand breaks. In the context of the study by Centre Hospitalier Universitaire Dijon, these regimens were evaluated as a first-line treatment with or without bevacizumab in elderly patients (aged 75 and older) with metastatic colorectal adenocarcinoma.
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