Recommendation for Caution with Irinotecan, Fluorouracil, and Leucovorin for Colorectal Cancer

To the Editor: In the September 28 issue of the Journal, Saltz et al. 1 reported the superiority of the chemotherapy combination of irinotecan, fluorouracil, and leucovorin over irinotecan alone or fluorouracil and leucovorin in the initial treatment of metastatic colorectal cancer. The results of this large clinical trial indicated that the three-drug combination was tolerable and not associated with a significantly increased incidence of toxicity as compared with the other two forms of treatment. The incidence of treatment-related death was approximately 1 percent during the study. The Food and Drug Administration (FDA) has approved this regimen of irinotecan, fluorouracil, and . . .