Until the early 1990s the medical treatment of colorectal cancer represented a therapeutic desert with little or no progress. Since then we have witnessed the establishment of effective adjuvant chemotherapy and the treatment of advanced disease has improved substantially. In the past year colorectal cancer has been at the cutting edge of new developments in medical oncology. Although some of these new treatments are still experimental and not yet standard practice, they are worth flagging up at this preliminary stage because the proof of principle they have established may herald a change in the way all cancer is treated in future.

Fluorouracil has represented the cornerstone of medical treatment of colorectal cancer for nearly 40 years, but it took until 1990 to show that adjuvant chemotherapy with fluorouracil with levamisole improved disease free and overall survival in Dukes's C (stage III) colon cancer.1 ^w1 Subsequent studies have shown that fluorouracil with folinic acid confers similar benefit but is less toxic and takes six months of treatment rather than a year.2 3 ^w2 This treatment improves absolute survival by an average of 5-10% at five years, which represents a 25-35% reduction in …