In 2004, Goldberg and colleagues established FOLFOX4 as the standard of care chemotherapy regimen in metastatic CRC when they demonstrated its superiority over two older regimens, IFL (bolus 5-FU/leucovorin/irinotecan) and IROX (irinotecan/oxaliplatin), in terms of prolonging median overall survival (OS), progression-free survival (PFS), and increased response.2 FOLFOX4 increased median survival time to 19.5 months compared to 15 months and 17.4 months for IFL and IROX respectively (p= .0001; HR .66, 95% CI 0.54-0.82). Time to progression was also significantly increased to 8.7 months compared to 6.9 and 6.5 months (p=.0014). Furthermore FOLFOX-4 effected a 45% overall response rate compared to 31% (p=.002) and 35% (p=.03) for IFL and IROX respectively. It also induced significantly less associated grade; 3 nausea, vomiting, diarrhea, febrile neutropenia, and dehydration than the other two regimens.