There are increasing reports showing the clinical significance of the p53 polymorphism status in terms of the response to chemotherapy. We investigated whether p53 polymorphism and mutation were associated with in vitro sensitivity to 5-fluorouracil (5-FU) in patients with colorectal cancer. Chemosensitivity to 5-FU was evaluated by the collagen gel droplet embedded culture drug sensitivity test. 5-FU sensitivity of tumor cells without inactive p53 mutation in the arginine/arginine (Arg/Arg) variant was significantly higher than that of tumor cells with or without inactive p53 mutation in other variants (p 5 0.022), whereas the 5-FU sensitivity of tumor cells with inactive p53 mutation in the Arg/Arg variant was significantly lower than that of tumor cells with or without inactive p53 mutation in other variants (p 5 0.002). In the Arg/Arg variant, apoptotic cells induced by 5-FU treatment in patients without inactive p53 mutation were more markedly increased than those in patients with inactive p53 mutation (p 5 0.037). Bax and Bcl-2 protein expressions in tumor tissue treated with 5-FU were associated with both 5-FU sensitivity and the apoptotic cell count. Our data show that the Arg/Arg genotype without inactive p53 mutation could be predictive of a more favorable response and the Arg/Arg genotype with inactive p53 mutation a less favorable response to chemotherapy using 5-FU in CRC. The combination of the p53 codon 72 polymorphism and p53 mutation status is a potential predictive marker of sensitivity to 5-FU in CRC.The p53 tumor suppressor gene encodes a nuclear protein that induces growth arrest or apoptosis in response to cellular stress. 1 Apoptosis is a fundamental mechanism by which DNA-damaging anticancer agents cause cytotoxicity. 2 p53 has a major function in transducing stress to the apoptotic machinery of cells, consistent with the importance of the p53 status as a determinant of the cellular response to DNA-damaging drugs. 3,4 The presence of an intact p53 function confers tumor sensitivity to DNA-damaging agents such as cisplatin. 5 However, p53 is mutated in at least 50% of human cancers. 6 The mutation site is widely distributed in DNA-binding domain including the amino acid part that is called hot spot as codons 175, 245, 248, 249, 273 and 282. In a recent analyses with a large number of patients, type of mutation (inactive TP53 mutations) and adjuvant treatment were identified as important factors in determining the prognostic significance of p53 mutation in colorectal cancer (CRC). 7,8 Another recent study has quantitated the functional activity of different p53 mutation with respect to their ability to transactivate target genes. There were 3 subtypes: mutants with no activity, mutants with significantly reduced but some residual activity and mutants with activity comparable with that of wild-type p53. 9 The most common p53 mutation in human tumors show a clear loss of transactivation activity. 10 We can designate p53 hot spot mutation as inactive p53 mutation. Inactive p53 mutation is impo...