Abstract
Purpose
A retrospective analysis was conducted to compare the tolerability and efficacy of single-agent capecitabine and 5-fluorouracil/leucovorin/irinotecan (FOLFIRI) in the first-line treatment of patients aged ≥65 years with metastatic colorectal cancer (mCRC).
Methods
Consecutive patients with mCRC treated at the Military Medical Institute, Warsaw, between January 2003 and June 2008 were eligible. A total of 123 patients were identified (FOLFIRI, n = 67; capecitabine, n = 56).
Results
The overall response rate with FOLFIRI was 28.1 versus 16.4% with capecitabine (P = 0.1398). Median time to disease progression with FOLFIRI was 8.8 versus 7.5 months with capecitabine (P = 0.20), and median overall survival was 19.0 versus 15.4 months (P = 0.93). In the FOLFIRI group, neutropenia and anaemia were significantly more frequent than in the capecitabine group. The main non-haematological toxicity was hand-foot syndrome found only in the capecitabine group.
Conclusion
Single-agent capecitabine and FOLFIRI are effective first-line regimens in patients aged ≥65 years with mCRC.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bennett RG, Greenought WBIII (1993) Approach to acute diarhoea in elderly. Gastrentrol Clin North Am 22:517–533
Cassidy J, Twelves C, Van Cutsem E et al (2002) First-line oral capecitabine therapy in metastatic colorectal cancer: a favorable safety profile compared with intravenous 5-fluorouracil/leucovorin. Ann Oncol 13:566–575
Common Toxicity Criteria (1993) In: Investigator’s handbook. A manual for participants in clinical trials of investigational agents sponsored by The Division of Cancer Treatment, National Cancer Institute, NIH 93-2770
Douillard JY, Cunningham D, Roth AD et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355:1041–1047
Dubsky P, Sevelda P, Jakesz R et al (2008) Anemia is a significant prognostic factor in local relapse-free survival of premenopausal primary breast cancer patients receiving adjuvant cyclophosphamide/methotrexate/5-fluorouracil chemotherapy. Clin Cancer Res 14:2082–2087
Feliu J, Escudero P, Llosa F et al (2005) Capecitabine as first-line treatment for patients older than 70 years with metastatic colorectal cancer: an Oncopaz Cooperative Group study. J Clin Oncol 23:3104–3111
Folprecht G, Seymour MT, Saltz L et al (2008) Irinotecan/fluorouracil combination in first-line therapy of older and younger patients with metastatic colorectal cancer: combined analysis of 2, 691 patients in randomized controlled trials. J Clin Oncol 26:1443–1451
Grothey A, Sargent D, Goldberg RM, Schmoll H-J (2004) Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil–leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol 22:1209–1214
Ho C, Ng K, O’Reilly S, Gill S (2005) Outcomes in elderly patients with advanced colorectal cancer treated with capecitabine: a population-based analysis. Clin Colorectal Cancer 5:279–282
Hoff PM, Ansari R, Batist G et al (2001) Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. J Clin Oncol 19:2282–2292
Jackson NA, Barrueco J, Soufi-Mahjoubi R et al (2009) Comparing safety and efficacy of first-line irinotecan/fluoropyrimidine combinations in elderly versus nonelderly patients with metastatic colorectal cancer. Cancer 115:2617–2629
Krzakowski M, Jassem J (2006) Zasady oceny wartości leczenia systemowego w onkologii. In: Krakowski M (ed) Onkologia Kliniczna. Wydawnictwo Medyczne Borgis, Warszawa, pp 653–655
Lagautriere F, Valvano L, Chaazl M et al (1998) Prognostic factors in colorectal adenocarcinoma. Ann Ital Chir 69:491–497
Lichtman SM, Villani G (2000) Chemotherapy in the elderly: pharmacologic considerations. Cancer Control 7:548–556
Nowacki M (2006) Rak jelita grubego. In: Krakowski M (ed) Onkologia Kliniczna. Wydawnictwo Medyczne Borgis, Warszawa, pp 889–907
Nowacki M, Bielecki K, Drews M (2003) Nowotwory jelita grubego. In: Szawłowski AW, Szmidt J (eds) Zasady diagnostyki i chirurgicznego leczenia nowotworów w Polsce. Fundacja-Polski Przegląd Chirurgiczny, Warszawa, p 226
O’Connell JB, Maggard AM, Ko CY (2004) Colon cancer survival rates with the new American Joint Committee on Cancer Sixth Edition Staging. J Natl Cancer Inst 96:1420–1425
Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. New Engl J Med 343:905–914
Seymour MT, Maughan TS, Wasan HS et al (2007) Capecitabine (Cap) and oxaliplatin (Ox) in elderly and/or frail patients with metastatic colorectal cancer: The FOCUS2 trial. J Clin Oncol 25(Suppl) (abstract 9030)
Van Cutsem E, Twelves C, Cassidy J et al (2001) Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol 19:4097–4106
Van Cutsem E, Nowacki M, Lang I et al (2007) Randomized phase III study of irinotecan and 5-FU/FA with or without cetuximab in the first-line treatment of patients with metastatic colorectal cancer (mCRC): the CRYSTAL trial. J Clin Oncol 25:18S (Suppl.) (abstr 4000)
Weissenberger C, Geissler M, Otto F et al (2006) Anemia and long-term outcome in adjuvant and neoadjuvant radiochemotherapy of stage II and III rectal adenocarcinoma: the Freiburg experience (1989–2002). World J Gastroenterol 12:1849–1858
Wojciechowska U, Didkowska J, Tarnowski W, Katoński (2006) In: Nowotwory złośliwe w Polsce w 2004 roku. Centrum Onkologii, Instytut im. Marii Skłodowskiej-Curie, pp 43–46
Yoshino T, Boku N, Onozawa Y et al (2007) Efficacy and safety of an irinotecan plus bolus 5-fluorouracil and l-leucovorin regimen for metastatic colorectal cancer in Japanese patients: experience in a single institution in Japan. Jpn J Clin Oncol 37:686–691
Acknowledgments
Support from the Military Institute of the Health Services, Warsaw, Poland, Grant No. WIM-1231/2004. The study sponsors had no involvement, on the study design, the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Conflict of interest statement
All authors declare no financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stec, R., Bodnar, L. & Szczylik, C. Feasibility and efficacy of capecitabine and FOLFIRI in patients aged 65 years and older with advanced colorectal cancer: a retrospective analysis. J Cancer Res Clin Oncol 136, 283–292 (2010). https://doi.org/10.1007/s00432-009-0660-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-009-0660-y