Modified FLOX as first-line chemotherapy for metastatic colorectal cancer patients in the public health system in Brazil: Effectiveness and cost-utility analysis

Abstract

Abstract. Incorporation of new drugs for treatment of metastatic colorectal cancer (mCRC) has led to a clear improvement in overall patient survival, the added cost of treatment, however, is a major concern worldwide. The cost-effectiveness of using a modified FLOX (mFLOX) regimen for treating mCRC patients was delineated. In this study, 82 consecutive mCRC patients were treated with leucovorin (LV) at 20 mg/m 2 in combination with weekly bolus of 5-fluorouracil (5-FU) (500 mg/m 2 ) for 6 consecutive weeks and oxaliplatin (85 mg/m 2 ) at weeks 1, 3 and 5, every 8 weeks. Overall survival (OS) and toxicity were evaluated. A Markov Model with a 2-year time horizon and 2-week cycles was developed, comparing mFLOX and mFOLFOX6 in a Brazilian environment. Health outcomes were measured in quality-ajusted life years (QALYs). The median overall period of survival was 19 months, while the estimated 1-year survival was 75%. Response by RECIST was assessed in 33 patients. Partial response was observed in 39.4% of patients, while 36.3% were stable. The mFLOX regimen cost was BRL 9,000, while the mFOLFOX6 BRL 22,000 (1 EUR=2.29 BRL), leading to an incremental costed of BRL 13,000, considering a 20-week period of first-line therapy. The incremental effect of the mFOLFOX was of 0,117 QALY. The incremental costeffectiveness ratio of mFOLFOX6 was of BRL 110,344/QALY. The sensitivity analysis detected no differences in the outcome measures. In conclusion, the mFLOX is an active regimen in mCRC patients, possibly providing a cost-effective option in public health systems.

The Effects of Palliative Chemotherapy in Metastatic Colorectal Cancer Patients With an ECOG Performance Status of 3 and 4

“…9 Some patients received monotherapy with a fluoropyrimidine; actually, more patients with an ECOG PS of 3/4 were treated with monotherapy compared with those with an ECOG PS of 2 (19.4% vs. 39.6%). However, because randomized trials have demonstrated that starting with either monotherapy or polychemotherapy does not influence the overall survival of mCRC patients with an ECOG PS of 0/1, 18 we do not believe survival differences among the ECOG groups could be explained by the choice of first-line therapy.…”

Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings

“…Of note, in a previous study from our institution, the use of mFLOX instead of FOLFOX as first-line therapy led to a cost decrease of R$13,000 (US$3,218) per patient for a treatment duration of 20 weeks. 17 Addition of irinotecan (FOLFOXIRI) or monoclonal antibodies (cetuximab, panitumumab, or bevacizumab) increases treatment costs. In the future, the availability of monoclonal antibody biosimilars may allow treatment intensification at an affordable cost for limited-resources settings.…”

“…This regimen does not require the use of an infusion pump and has a lower cost than the other regimens mentioned earlier. 17 We aimed to evaluate surgical and survival outcomes of patients with B/U liver metastases from CRC treated by using conversion chemotherapy with mFLOX followed by surgical resection.…”

Adverse drug reaction: a comparative analysis of protocols used for treatment of colorectal cancer

“…29,30 Destaca-se ainda, o uso de medidas profiláticas e o manejo das reações leves e/ou moderadas como importantes possibilidades a serem adotadas para que se evite desfechos mais graves que comprometam o tratamento. 31 Todas essas estratégias, além de agregarem benefícios clínicos, são capazes de promover economicidade aos serviços e sistemas de saú-de, 32,33,34 devendo ser adequadamente analisadas pelos profissionais de saúde no momento da definição do protocolo que será utilizado.…”