Chemotherapy Drugs for Bowel Cancer

5-Fluorouracil (5-FU) and Folinic Acid (Leucovorin) - The mainstays of advanced colorectal cancer treatment for half a century and still widely used in the UK. 5-FU works by blocking the enzymes in cancerous cells, slowing down or even stopping their growth. 5-FU's effectiveness is enhanced when folinic acid, a vitamin, is used in combination with it.

Oxaliplatin (Eloxatin) - Recommended by the National Institute for Health and Clinical Excellence (NICE) for the treatment of advanced metastatic colorectal cancer in the first and second line treatment of the disease in combination with 5-FU and folinic acid (known as FOLFOX). Eloxatin has also been approved by NICE for use in the adjuvant setting (i.e. after surgery).

Irinotecan (Campto) - Recommended by NICE for the treatment of advanced metastatic colorectal cancer in the first line treatment of the disease, in combination with 5-FU and folinic acid (known as FOLFIRI), and as second line monotherapy treatment, i.e. on its own.

Capecitabine (Xeloda) - Recommended by NICE as an oral alternative to intravenous 5-FU/folinic acid. for bowel cancer patients with Stage III (Dukes C) disease, following surgery, and also as first line treatment for patients with advanced colorectal cancer. Xeloda is administered orally in tablet form twice a day. Once absorbed the tablets are converted to 5-FU.

Tegafur Uracil (UFToral) - Recommended by NICE in the first line treatment of advanced colorectal cancer as an alternative to intravenous 5-FU/folinic acid. UFToral is administered orally in tablet form three times a day. Once absorbed, the body converts them into 5-FU.

Cetuximab (Erbitux) - Known as a monoclonal antibody or biological agent. Not a conventional chemotherapy but a drug that targets the process of tumour growth. Erbitux can be administered on its own or in combination with Irinotecan. Patients must express the 'K- Ras' wild type gene to be suitable for this treatment. Currently approved by NICE in limited circumstances.

Bevacizumab (Avastin) - Also a monoclonal antibody or biological agent, it works by reducing the blood supply to the tumour. Currently not approved by NICE, but may been made available by PCTs through the new interim cancer drugs fund in certain situations.

Panitumimab (Vectibix) - Works in a similar way to Cetuximab and is suitable for patients expressing the K-Ras wild type gene and the EGFR (epidermal growth factor receptor) which it binds to and blocks signals that stimulate growth of cancer cells. This drug is given on its own and is used where there are no more chemotherapy options.