FOLFOX Alternated with FOLFIRI as First-Line Chemotherapy for Metastatic Colorectal Cancer

Aparicio, Jorge; Fernández-Martos, Carlos; Vicent, J. M.; Maestu, Inmaculada; Llorca, C.; Busquier, Isabel; Campos, J.M.; Pérez-Enguix, D.; Balcells, Miquel

doi:10.3816/ccc.2005.n.037

Cited by 29 publications

(16 citation statements)

References 19 publications

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“…Although these resources are particularly useful to manage acute neurotoxicity, and probably contribute to a reduction in late-onset cumulative L-HOP neurotoxicity, they are time consuming and often difficult to be given on an outpatient basis. Other treatment options, such as sequential or alternating regimens, may also lead to mild toxicity and a low incidence of severe L-HOP-induced neurotoxicity [17, 18]. …”

Section: Discussionmentioning

confidence: 99%

FOLFOX-4 Stop and Go and Capecitabine Maintenance Chemotherapy in the Treatment of Metastatic Colorectal Cancer

Petrioli¹,

Paolelli²,

Marsili³

et al. 2006

Oncology

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Objective: Patients with metastatic colorectal cancer (MCC) usually receive FOLFOX-4, or other oxaliplatin (L-HOP)-based regimens, until the occurrence of progressive disease, with an increase in the incidence of neurotoxicity which is correlated to the cumulative dose of L-HOP. The aim of this study was to evaluate if FOLFOX-4 stop and go and capecitabine maintenance chemotherapy is associated with a low incidence of severe neurotoxicity in the treatment of MCC patients. Methods: Thirty-three patients were treated with FOLFOX-4 (L-HOP 85 mg/m² day 1, leucovorin 200 mg/m², 5-fluorouracil bolus 400 mg/m² and 22 h 600 mg/m² days 1 and 2, every 2 weeks). Patients who achieved objective response (OR) or stable disease (SD) then received oral capecitabine 2,500 mg/m² days 1–14 every 3 weeks; L-HOP was reintroduced as soon as progression occurred. Results: Twenty-eight of the 29 patients who achieved OR or SD then received capecitabine. FOLFOX-4 was reintroduced in 18 patients (56.2%). The median response duration (RD) was 9.2 months and median progression-free survival (PFS) was 8.6 months. Twenty-eight patients (87.5%) had peripheral neuropathy during treatment, but grade 3 neurotoxicity was observed in only 1 patient (3.1%). Conclusions: FOLFOX-4 stop and go and capecitabine maintenance chemotherapy was associated with a very low incidence of grade 3 neurotoxicity. Although the number of patients enrolled was far too low for a definite conclusion, RD and PFS were comparable to those usually reported in the treatment of MCC patients.

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Section: Discussionmentioning

confidence: 99%

FOLFOX-4 Stop and Go and Capecitabine Maintenance Chemotherapy in the Treatment of Metastatic Colorectal Cancer

Petrioli¹,

Paolelli²,

Marsili³

et al. 2006

Oncology

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“…5-FU-based regimens, along with little neurotoxicity and myelotoxicity (Aparicio et al, 2005;Ferrari et al, 2005;Hebbar et al, 2006). Cassinello et al (2006) reported a somewhat lower ORR of 37% and OS of 16.4 months for a regimen comprising oxaliplatin on day 1 with capecitabine on days 1 -14 of a 21-day cycle, followed by irinotecan on day 1 plus capecitabine on days 1 -14 of a second 21-day cycle.…”

Section: Discussionmentioning

confidence: 99%

Alternating irinotecan with oxaliplatin combined with UFT plus leucovorin (SCOUT) in metastatic colorectal cancer

et al. 2008

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Tegafur -uracil (UFT) plus leucovorin s (LV, folinic acid) with alternating irinotecan and oxaliplatin were effective and well tolerated in patients with metastatic colorectal cancer (mCRC) in a phase I study. This study expanded the maximum tolerated dose group. Patients aged X18 years had histologically confirmed, inoperable, previously untreated, measurable mCRC. Patients received irinotecan 180 mg m À2 on day 1, oxaliplatin 100 mg m À2 on day 15 and UFT 250 mg m À2 plus LV 90 mg on days 1 -21 every 28 days. The phase I/II study comprised 45 patients, 29 at the maximum tolerated dose (MTD). The response rate in 38 evaluable patients was 63% (95% confidence interval (CI): 49 -80). Median time to progression and overall survival were 8.7 months (95% CI: 7.9 -10.4) and 16.8 months (95% CI: 9.6 -25.3), respectively. In the MTD group, one patient had grade 3 leucopaenia; one had grade 3 neutropaenia; three had grade 3 diarrhoea; and one had grade 3 neurotoxicity. No hand -foot syndrome grade 41 was seen. In total, 67% of eligible patients received second-line therapy. UFT plus LV with alternating irinotecan and oxaliplatin is an efficacious first-line treatment for mCRC, with minimal neurotoxicity and hand -foot syndrome.

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“…To improve response and survival, other alternating regimens have been examined. Alternating oxaliplatin and irinotecan in association with the De Gramont regimen has been used in first- and second-line chemotherapy for metastatic colorectal cancer [17]. Seventy-nine patients with previously untreated, unresectable colorectal cancer were included in a study of this regimen as a first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

Phase II Trial of Alternating mFOLFOX6 and FOLFIRI Regimens in the First-Line Treatment for Unresectable or Metastatic Colorectal Cancer (KSCC0701)

et al. 2013

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Objective: This phase II study examined the efficacy and safety of alternating regimens of mFOLFOX6 and FOLFIRI as a first-line treatment for unresectable or metastatic colorectal cancer. Patients and Methods: Forty-eight patients were enrolled in this study. Patients received an alternating regimen of 4 cycles of mFOLFOX6 followed by 4 cycles of FOLFIRI. Results: The characteristics of the study population were as follows: males/females 34/12, median age 66 years (range 43–75) and Eastern Cooperative Oncology Group performance status 0/1/2 in 37/9/0 patients. The overall response rate was 58.7% [95% confidence interval (CI) 43.9–73.5]. The median progression-free survival was 10.3 months (95% CI 7.5–11.9), and the median overall survival was 28.4 months (95% CI 22.5–35.7). Among the 47 patients evaluated for toxicity, the most common grade 3–4 adverse events were leukopenia (26%), neutropenia (55%), anemia (4%), neurotoxicity (0%), diarrhea (2%), febrile neutropenia (4%), nausea (4%), vomiting (2%), and hypersensitivity (0%). Conclusions: The results of this phase II study indicate that this alternating schedule is effective and well tolerated as a first-line treatment for unresectable or metastatic colorectal cancer. The low rate of grade 3 neurotoxicity is also promising.

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FOLFOX Alternated with FOLFIRI as First-Line Chemotherapy for Metastatic Colorectal Cancer

Cited by 29 publications

References 19 publications

FOLFOX-4 Stop and Go and Capecitabine Maintenance Chemotherapy in the Treatment of Metastatic Colorectal Cancer

FOLFOX-4 Stop and Go and Capecitabine Maintenance Chemotherapy in the Treatment of Metastatic Colorectal Cancer

Alternating irinotecan with oxaliplatin combined with UFT plus leucovorin (SCOUT) in metastatic colorectal cancer

Phase II Trial of Alternating mFOLFOX6 and FOLFIRI Regimens in the First-Line Treatment for Unresectable or Metastatic Colorectal Cancer (KSCC0701)

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