Folinic acid and 5-fluorouracil as adjuvant chemotherapy in colon cancer

Francini, Guido; Petrioli, Roberto; Lorenzini, L; Mancini, Sergio; Armenio, S; Tanzini, G.; Marsili, Stefania; Aquino, A; Marzocca, G.; Civitelli, Serenella; Mariani, L; Sando, D. De; Bovenga, S; Lorenzi, Marco

doi:10.1016/0016-5085(94)90748-x

Cited by 213 publications

(112 citation statements)

References 44 publications

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“…Since the antitumor activity of fluorouracil was enhanced in the metastatic setting when administered with leucovorin 37 , the combination of fluorouracil and leucovorin was evaluated in the adjuvant setting, where it was found to improve disease-free and overall survival [70][71][72][73] . A pooled analysis of seven randomized trials of postoperative fluorouracil-based therapy versus surgery alone demonstrated an increase in five-year disease-free survival from 42% to 58% and five-year overall survival from 51% to 61% in patients with stage III disease 74 .…”

Section: Adjuvant Therapy With Fluoropyrimidines For Stage III Colmentioning

confidence: 99%

Systemic Treatment of Colorectal Cancer

2008

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Colorectal cancer is the fourth most common non-cutaneous malignancy in the United States and the second most frequent cause of cancer-related death. Over the past 12 years, significant progress has been made in the systemic treatment of this malignant condition. Six new chemotherapeutic agents have been introduced, increasing median overall survival for patients with metastatic colorectal cancer from less than 9 months with no treatment to approximately 24 months. For patients with stage III (lymph node positive) colon cancer, an overall survival benefit for fluorouracil-based chemotherapy has been firmly established, and recent data have shown further efficacy for the inclusion of oxaliplatin in such adjuvant treatment programs. For patients with stage II colon cancer, the use of adjuvant chemotherapy remains controversial, but may be appropriate in a subset of individuals at higher risk for disease recurrence. Ongoing randomized clinical trials are evaluating how best to combine currently available therapies, while smaller studies are evaluating new agents, with the goal of continued progress in prolonging life among patients with metastatic colorectal cancer and increasing cure rates among those with resectable disease.

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Section: Adjuvant Therapy With Fluoropyrimidines For Stage III Colmentioning

confidence: 99%

Systemic Treatment of Colorectal Cancer

2008

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“…In particular, several investigators have found that substantial percentages of older individuals with stage III (node-positive) colon cancer do not receive chemotherapy [5,6], and this is particularly marked among black elderly [5][6][7]. This is of great concern, because chemotherapy is associated with substantially better survival in stage III colon cancer [8][9][10][11][12][13], and the beneficial effects of chemotherapy are still apparent in older adults [8,14,15], at least up to age 80. For example, in randomized controlled trials, the 5-year survival rate for stage III colon cancer patients without chemotherapy was approximately 50%, whereas this rate was approximately 70% for those receiving chemotherapy [9-12, 15, 16].…”

Section: Introductionmentioning

confidence: 99%

Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

Luo¹,

Giordano

Freeman

et al. 2006

The Oncologist

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Purpose. Adjuvant chemotherapy for stage III colon cancer produces a substantial survival benefit, but many older patients do not receive chemotherapy. This study examines factors associated with medical oncology consultation and evaluates the impact of such consultation on chemotherapy use.Patients and Methods. We used the Surveillance Epidemiology and End Results-Medicare linked database and identified 7,569 patients, aged 66-99, with stage III colon cancer diagnosed from 1992-1999. Modified Poisson regression was used to assess the relative risk for seeing a medical oncologist and for receiving chemotherapy as a function of individual characteristics.Results. 78.08% of patients saw a medical oncologist within 6 months of diagnosis. Patients who were female, white, married, had low comorbidity scores, were diagnosed in more recent years, or had four or more positive lymph nodes were more likely to see a medical oncologist. Patients seeing a medical oncologist were 10 times more likely to receive chemotherapy (odds ratio, 9.98; 95% confidence interval, 8.21-12.14), after controlling for demographic and tumor characteristics. Chemotherapy use increased over time, but was substantially lower among older, black, and unmarried patients.Conclusions. Referral to medical oncology is one of the most important factors associated with receipt of chemotherapy among older patients with stage III colon cancer. Comorbidity decreases the likelihood of receiving chemotherapy, but its effect is the same for those who see a medical oncologist and all patients combined. Ensuring that high-risk patients are referred to medical oncology is a crucial step in quality care for patients with colon cancer.

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“…5-Fluorouracil (5-FU) alone or in combination with biomodulators, such as folinic acid (FA), levamisol, interferon alpha, has long been the only systemic treatment in adjuvant setting and advanced stage of disease (Francini et al, 1994;Grem, 1996;O'Connell, 1998;Von Hoff, 1998;Skibber, 2001), but new drugs such as CPT-11 and the novel platinum derivative oxaliplatin have recently been successfully combined with 5-FU in different administration schedules and dosages (Skibber, 2001;Von Hoff, 1998). The combination of oxaliplatin with FA and infusional 5-FU (FUFA) is currently being investigated by the American Food and Drug Administration (FDA) in the first-line treatment for advanced colorectal carcinoma.…”

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confidence: 99%

A novel biweekly multidrug regimen of gemcitabine, oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) in pretreated patients with advanced colorectal carcinoma

Correale

Messinese

Caraglia³

et al. 2004

Br J Cancer

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Previous results suggest that GEM affects 5-fluorouracil (5-FU) metabolism and pharmacokinetics in cancer patients, while combined with oxaliplatin, levo-folinic acid, and 5-FU (GOLF regimen), at doses achievable in cancer patients, determines high cytotoxic and proapoptotic antitumour activity in colon cancer cells in vitro. On these bases we designed a phase I -II clinical trial testing the GOLF regimen in patients with metastatic colorectal carcinoma, who had received at least a prior line of chemotherapy. In total, 29 patients (20 males and nine females) enrolled in the study received every 2 weeks, gemcitabine (patients #1 -3 received 600 mg m À2 ; patients # 4 -6 received 850 mg m À2 ; while patients # 7 -29 received 1000 mg m À2 ) on the day 1, levo-folinic acid (100 mg m À2 ) on the days 1 and 2; 5-fluorouracil (400 mg m À2 ) in bolus injection, followed by a 22-h continuous infusion (800 mg m À2 ) on the days 1 and 2, and oxaliplatin (85 mg m À2 ), 6 h after the 5-FU bolus on day 2. The most frequent side effect was grade I -II haematological toxicity. In total, 28 patients were evaluable for response: three achieved a complete response, nine a partial response, 10 had a stable disease, and six progressed. The average time to progression and overall survival of the patients was, respectively, 7.26 and 22 months. Our GOLF combination is well tolerated and seems promising for the treatment of advanced colorectal cancer.

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Folinic acid and 5-fluorouracil as adjuvant chemotherapy in colon cancer

Cited by 213 publications

References 44 publications

Systemic Treatment of Colorectal Cancer

Systemic Treatment of Colorectal Cancer

Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

A novel biweekly multidrug regimen of gemcitabine, oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) in pretreated patients with advanced colorectal carcinoma

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