Fluorouracil Supplemented With Oxaliplatin or Irinotecan for Solid Tumors: Indications From Clinical Characteristics and Health Outcomes of Patients

Abstract

Fluorouracil combined with oxaliplatin (FOLFOX) and fluorouracil combined with irinotecan (FOLFIRI) are both first-line clinical chemotherapy regimens. However, clinicians' selection of FOLFIRI or FOLFOX medication regimens and their effects on patients' health outcomes are not clear. The aim of this study was to evaluate the impacts on patient characteristics of FOLFIRI or FOLFOX medication regimen selection and the effects of each regimen on patients' health outcomes in a real-world setting. Three thousand seven hundred and twenty-five patients were retrieved and 610 of them were eventually included in this study based on the inclusion and exclusion criteria. The percentages of the TNM stage, cetuximab, bevacizumab, and tumor metastases between the FOLFIRI and FOLFOX groups were different ( P < 0.001). In the multivariate Cox proportional hazards model, a significantly higher non-convalescent incidence of the FOLFOX group was found as compared with the FOLFIRI group (HR = 2.211, 95% CI = 1.257–3.888, P = 0.006). In conclusion, the TNM stage, whether combined with cetuximab or bevacizumab, and whether there was tumor metastasis presented as the key factors affecting medication selection between the FOLFIRI and FOLFOX regimens. The FOLFIRI regimen exhibited better effects on patients' long-term health outcomes than did the FOLFOX regimen. This study was registered on the World Health Organization International Clinical Trials Registry Platform (ChiCTR2000029201). Trial registration: ChiCTR2000029201.

Effectiveness and Cost-Utility Analysis of Different Doses of Irinotecan Plus Bevacizumab in Patients With Metastatic Colorectal Cancer: A Long-Term and Prospective Cohort Study

“…This intention-to-treat (ITT) analysis also demonstrated the benefits of escalating doses of irinotecan under UGT1A1 genotyping. Likewise, other previous studies have also suggested that higher doses of irinotecan in the first-line or later-line setting in mCRC can confer favorable clinical outcomes ( 4 – 7 ).…”

“…The exclusion criteria were as follows: (a) no receipt of bevacizumab plus FOLFIRI, (b) the UGT1A1 genotype 7TA/7TA ( UGT1A1*28*28 ); (c) <20 or >80 years of age; (d) no dose esclation due to discomfort experienced by those in the dose escalation group; (e) being pregnant or breastfeeding; (f) a major comorbidity; and (g) having not signed the consent form. The recommended irinotecan dose in the FOLFIRI regimen is 180 mg/m 2 based on a dose-finding study ( 2 , 4 , 10 ). The detailed treatment regimen on irinotecan dose escalation including patient withdrawal was described in our previous study protocol ( 11 ).…”

The effective combination therapies with irinotecan for colorectal cancer

“…In Japan, the cost of chemotherapy with FOLFIRI was lower than that of oxaliplatin-based chemotherapy regimens (FOLFOX, oxaliplatin plus 5-FU/leucovorin), and the use of lower-cost chemotherapy regimens as first-line chemotherapy could reduce the overall cost of the entire chemotherapy course ( Yajima et al, 2015 ). Due to the differences in toxicity between the two regimens, the FOLFIRI regimen is superior to the FOLFOX regimen from the standpoint of long-term health outcomes ( Qingwei et al, 2020 ).…”