Irinotecan, leucovorin and 5-fluorouracil (modified FOLFIRI) as salvage chemotherapy for frail or elderly patients with advanced gastric cancer

Abstract

Abstract. We retrospectively evaluated the efficacy and safety of the modified FOLFIRI regimen in frail or elderly patients with advanced gastric cancer (AGC). We reviewed 24 frail [Eastern Cooperative Oncology Group performance status (ECOG PS) of 2] or elderly (65 years or over) patients with AGC who received the modified FOLFIRI regimen as salvage chemotherapy. Patients received irinotecan 150 mg/m 2 and leucovorin (LV) 100 mg/m 2 as a 2 h intravenous infusion, followed by 5-fluorouracil (5-FU) 2,000 mg/m 2 as a 46 h continuous infusion. Among the 24 patients, 18 (75%) had an ECOG PS of 2, and 11 (45.8%) were aged 65 years or over. A total of 113 cycles were conducted, with a median number of 4 cycles per patient. A total of 3 patients achieved partial response (PR) and 8 demonstrated stable disease (SD). On an intent-to-treat basis, the overall response rate (RR) was 12.5% and the disease control rate (PR and SD) was 45.8%. The median time to progression (TTP) was 2 months [95% confidence interval (CI), 1.9-2.1 months] and the median overall survival (OS) was 5.4 months (95% CI, 4.1-6.7 months). Grade 3-4 hematological toxicities, including neutropenia, anemia and thrombocytopenia, were observed in 6 (25%), 4 (16.7%) and 1 (4.2%) patients, respectively. Additionally, 3 (12.5%) patients developed febrile neutropenia, of which 1 succumbed to pneumonia. Grade 3-4 gastrointestinal toxicities, including nausea, vomiting, diarrhea and mucositis, were observed in 3 (12.5%), 2 (8.3%), 1 (4.2%) and 1 (4.2%) patients, respectively. In conclusion, the modified FOLFIRI regimen as salvage chemotherapy for AGC patients over 65 years of age or with a poor PS was effective and acceptable. These results suggest that this regimen may be an effective option for frail or elderly patients with AGC.

Efficacy and Safety of FOLFIRI Regimen in Elderly Versus Nonelderly Patients with Metastatic Colorectal or Gastric Cancer

“…Most patients in this study had an ECOG PS of 0–1 (83.4%) and were in a first‐line setting (92.9%). In another study reported by Kim and colleagues, 75% of patients were ECOG PS 2, and 45.8% were older than 65 years . The response rate was 12.5%, the median time to progression was 2 months, and the median OS was 5.4 months.…”

“…In metastatic GC, previous studies suggest that irinotecan‐based doublet regimens could be an active treatment option in elderly patients . Fonck et al reported that patients with advanced or metastatic GC aged 70 years or older showed a response rate of 26%, a median PFS of 7 months, and a median OS of 10 months .…”

“…Therefore, it is still under debate whether irinotecan plus fluoropyrimidine doublet chemotherapy could be a standard mainstay for elderly patients with metastatic CRC. In metastatic GC, previous studies support that an irinotecan‐based regimen could be an effective therapeutic option in elderly patients . However, the experience of irinotecan‐based chemotherapy is still limited in this subset of patients.…”

Safety and Efficacy of Combined Yttrium 90 Resin Radioembolization with Aflibercept and FOLFIRI in a Patient with Metastatic Colorectal Cancer

“…A baseline MRI showed 3 liver metastases, with largest lesion in the right lobe measuring 9.4 cm in the largest diameter. She was started on aflibercept and FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) repeated every 2 weeks, with the first cycle on 06/17/2013, receiving intravenously aflibercept = 4 mg/Kg, irinotecan = 150 mg/m 2 , leucovorin = 100 mg/m 2 , and fluorouracil = 2000 mg/m 2 [ 16 ]. After the first cycle the patient underwent radioembolization with yttrium 90 resin microspheres targeting the largest right lobe hepatic tumor (07/03/13).…”

Clinical significance of chemotherapy for geriatric patients with advanced or recurrent gastric cancer

“…Previous studies have indicated the superiority of systemic chemotherapy compared to best supportive care (BSC) in patients with advanced or recurrent GC (3)(4)(5) and several phase III trials investigating systemic chemotherapy in advanced GC patients have been conducted (6)(7)(8)(9)(10)(11). Recently, several clinical trials assessed the tolerability or efficacy of systemic chemotherapy, including adjuvant chemotherapy, in geriatric patients with advanced or recurrent GC and demonstrated its feasibility (12)(13)(14)(15)(16)(17). However, the effect of systemic chemotherapy in the prognosis of geriatric patients with advanced or recurrent GC remains unclear.…”