Adjuvant Chemotherapy in Colorectal Cancer: Mournful, Hopeful Perpetual Motion Machine Heads to Dim Light at End of Tunnel-Reply

In Reply. —  We agree entirely with Dr Clouse that adjuvant therapy trials in colon cancer that have been completed and reported in the medical literature have failed to document unequivocally a significant benefit. Observation following curative resection remains appropriate standard medical practice. However, we disagree emphatically with his statement that "we do not need yet another trial of adjuvant chemotherapy for colorectal cancer." Modest but nevertheless significant advances in the therapy of advanced colorectal cancer have been achieved by the biochemical modulation of 5-fluorouracil by leucovorin,^1-3 and this combination certainly deserves testing in the adjuvant setting. This currently is being carried out as an intergroup trial under the auspices of the National Cancer Institute, which has designated this a "high priority" study of national importance. Furthermore, preliminary data using levamisole alone or in combination with 5-fluorouracil⁴ provide some evidence that biologic response modifiers might be effective in