Chemotherapy for advanced bowel cancer

Sometimes your multi-disciplinary team will decide that surgery is unlikely to be an option for you, or that it could be an option at a later date but other treatment is needed first.


Combinations of chemotherapy and targeted therapies (also called biological therapies) are being used with increasing success to treat a greater number of patients with bowel cancer metastases in the liver and other organs. The purpose of these types of treatments is to shrink the tumours down and kill the cancer cells, sometimes bringing them to a point where they can be removed with surgery, or safely targeted with other kinds of treatment.


The standard chemotherapy drugs for metastases are the same as the ones used to treat cancer in the bowel (colon or rectum). They can be given on their own, in different combinations at the same time, or given one after the other, depending on your own particular circumstances.


You may recognise some of the names of the individual drugs: oxaliplatin, irinotecan, 5FU and capecitabine.


These are some of combinations currently being used:


  • FOLFOX – 5FU and leucovorin with oxaliplatin
  • FOLFIRI – 5FU and leucovorin with irinotecan
  • FOLFOXIRI – 5FU and leucovorin with both oxaliplatin and irinotecan
  • CAPOX or XELOX – capecitabine with oxaliplatin
  • CAPIRI or XELIRI – capecitabine with irinotecan


Please refer to our chemotherapy section for more information about these drugs.


Raltitrexed may be prescribed instead for people who cannot tolerate 5FU or who have a previous history of coronary heart disease.


Leucovorin (folinic acid) is not a chemotherapy drug, but when used in combination with 5FU it has been shown to increase its effectiveness.


With the exception of the capecitabine capsules, all these drugs are given as an intravenous infusion (a drip into a vein).


A new treatment called Lonsurf (Trifluridine and Tipiracil) is now available all over the UK for patients with advanced bowel cancer.  It is an option to prolong life in patients who have tried at least two other drug treatments for advanced cancer, regardless of  their RAS status or resistance to previous lines of treatment. Your oncologist will be able to discuss if this is an option for you.