The modified FOLFOXIRI combination chemotherapy showed a very promising preliminary antitumor activity and was generally well tolerated as a first-line treatment of patients with metastatic gastric cancer.

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The emergence of multidrug resistance (MDR) in cancer cells has made many of the currently available chemotherapeutic agents ineffective. However, the mechanism involved in mediating this effect is not yet fully understood. Here, we found the overexpression of type I insulin‐like growth factor receptor (IGF‐IR) in established colorectal MDR cells. Specific siRNA of IGF‐IR decreases cell proliferation, exert synergistic effect with anticancer drugs. The downstream signaling of IGF‐IR, PI3K/AKT pathway, was altered upon IGF‐IR silencing. The expression of multidrug‐resistance‐associated protein 2 (MRP‐2) was suppressed due to the nuclear translocation of nuclear factor‐like 2 (Nrf2). Then the intracellular drug concentration was increased and the drug‐resistant phenotype was reversed. Our findings improve current understanding of the biology of IGF‐IR and MDR and have significant therapeutic implications on colorectal MDR cancer. J. Cell. Biochem. 113: 2086–2097, 2012. © 2012 Wiley Periodicals, Inc.