OBJECTIVES: To describe chemotherapy regimens used and to estimate costs of chemotherapy regimens, supportive care and medical procedures in the first-, second-, third- and fourth-line treatment of patients with metastatic colorectal cancer in Serbia (part of a multinational study in central Europe). METHODS: An online questionnaire was used to collect necessary information in this opinion-based study. All information concerning treatment of colorectal cancer was based on experts opinion from four oncology centers in Serbia. Oncologists had access to medical records of approximately 1760 patients treated in year 2008. RESULTS: The leading first-line regimen (38% of patients) was Mayo (Folinic acid, 5-FU). The most commonly prescribed second-line regimen (46%%) was FOLFOX 4. Modified FOLFIRI (Irinotecan, Folinic acid, 5-FU) was the most popular regimen in the third line (35%), while FOLFIRI/cetuximab (35%) was the most commonly used fourth-line regimen. The percentage of patients receiving supportive care was 7%, 5%, 10% and 56% in the first, second, third, and fourth lines, respectively. The most common treatment path (8%) was FOLFOX 4 B in the first line, FOLFIRI B in the second and Mitomicin mono in the third. Mean regimen costs per patient were estimated from a public payer perspective. The most expensive regimen in the first line was bevacizumab + capecitabine + oxaliplatin (€21,126) the same regimen was also the most expensive in the second line (€13,366), irinotecan/cetuximab in the third line (€25,633) and FOLFIRI/cetuximab in the fourth line (€6,479). CONCLUSIONS: New chemotherapeutic agents are associated with improvements in survival time but also with substantial costs. Factors influencing the selection of chemotherapy included: previous therapies, course of the disease, the patient’s performance status, adverse events after previous chemotherapies and concomitant diseases. However, open-ended coverage policies for new chemotherapeutic agents may prove difficult to sustain as costs continue to rise.