[Expert consensus on the clinical application of the Chinese-modified triplet combination with irinotecan, oxaliplatin and continuous infusional 5-fluorouracil / leucovorin for colorectal cancer (2026 edition)].

Résumé

Chemotherapy is the cornerstone of colorectal cancer treatment, especially for microsatellite stable/proficient mismatch repair (MSS/pMMR) colorectal cancer. The FOLFOXIRI triplet regimen (fluorouracil, oxaliplatin, and irinotecan) is an intensive chemotherapy regimen for colorectal cancer, characterized by remarkable efficacy but relatively high toxicity. In 2021, to promote the standardized and rational clinical use of the FOLFOXIRI regimen among Chinese clinicians, the Colorectal Cancer Committee of the China Southwest Oncology Group led a panel of experts in relevant fields. Based on the characteristics of the Chinese population, the mechanisms of the three chemotherapeutic agents, and previous research data, they formulated the "Chinese expert consensus on the clinical application of the Chinese modified triplet combination with irinotecan, oxaliplatin and continuous infusional 5-fluorouracil / leucovorin for colorectal cancer". This consensus proposed the first time the dosage, administration, and adverse event management of the cmFOLFOXIRI regimen, leading to its wide recognition and clinical implementation. Over the five years since the initial consensus was published, multiple key studies have been updated, and numerous new clinical trials based on the FOLFOXIRI regimen have been conducted globally. Meanwhile, the population of patients with colorectal cancer has become increasingly younger, indicating that the modified cmFOLFOXIRI triplet regimen will be applied in more clinical scenarios. Accordingly, the Colorectal Cancer Committee of the China Southwest Oncology Group has led an update of the 2021 Chinese expert consensus on the clinical application of the Chinese modified triplet combination with irinotecan, oxaliplatin and continuous infusional 5-fluorouracil / leucovorin for colorectal cancer. The 2026 edition highlights updated evidence for first-line palliative therapy, conversion therapy, and neoadjuvant therapy; adds expert recommendations on using capecitabine to replace 5-FU in the triplet regimen and recent advances in the use of the triplet regimen for salvage therapy; and provides further information on the tolerability and adverse event management of cmFOLFOXIRI. These updates strengthen the evidence base for the efficacy and safety of the cmFOLFOXIRI regimen and further promote its standardized, precise, and personalized clinical application.