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Yiqi Zhuyu Decoction (益气逐瘀汤) Combined with FOLFOX-4 as first-line therapy in metastatic colorectal cancer

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Abstract

Objective

To evaluate the efficacy and safety of Yiqi Zhuyu Decoction (益气逐瘀汤, YZD) combined with oxaliplatin plus 5-flurouracil/leucovorin (FOLFOX-4) in the patients with metastatic colorectal cancer (MCRC).

Methods

A total of 120 patients with MCRC were randomly divided into the experimental group (FOLFOX-4 plus YZD, 60 cases) and the control group (FOLFOX-4 plus placebo, 60 cases), according to the sequence of hospitalization from January 2005 to December 2007. The treatment was supposed to be continued until disease progression (PD) or for 48 weeks (i.e., up to 24 cycles of FOLFOX-4). Response rate (RR), progression-free survival (PFS), overall survival (OS) and adverse events (AEs) were observed.

Results

RR was 41.5% in the experimental group and 34.0% in the control group [odds ratio (OR): 1.18, 95% CI: 0.77 to 1.82, P=0.432]. Median PFS were 9.0 months and 8.0 months, respectively [hazard ratio (HR): 0.78, 95% CI: 0.53 to 1.15, P=0.215]. Median OS were 21.0 months and 18.0 months (HR: 0.65, 95% CI: 0.43 to 0.99, P=0.043) and grade 3/4 AEs were 56.6% and 76.7% (OR: 0.61, 95% CI: 0.18 to 0.87, P=0.020), respectively.

Conclusions

YZD combined with FOLFOX-4 chemotherapy significantly improved OS in this first-line trial in the patients with MCRC and significantly decreased grade 3/4 AEs. However, RR was not improved, and PFS did not reach statistical significance by the addition of YZD. The treatment of YZD combined with FOLFOX-4 may be necessary in order to optimize efficacy and safety.

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References

  1. Weitz J, Koch M, Debus J, Hohler T, Galle PR, Buchler MW. Colorectal cancer. Lancet 2005;365:153–165.

    Article  PubMed  Google Scholar 

  2. Arnold CN, Goel A, Blum HE, Boland CR. Molecular pathogenesis of colorectal cancer. Cancer 2005;104:2035–2047.

    Article  PubMed  CAS  Google Scholar 

  3. Lorenz M, Staib-Sebler E, Hochmuth K, Lorenz M, Staib-Sebler E, Hochmuth K, et al. Surgical resection of liver metastases of colorectal carcinoma: short and long-term results. Semin Oncol 2000;27:112–119.

    PubMed  CAS  Google Scholar 

  4. Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 2004;22:23–30.

    Article  PubMed  CAS  Google Scholar 

  5. Grothey A, Sargent D. Overall survival of patients with advanced colorectal cancer correlates with availability of fluorouracil, irinotecan, and oxaliplatin regardless of whether doublet or single-agent therapy is used first line. J Clin Oncol 2005;23:9441–9442.

    Article  PubMed  Google Scholar 

  6. Hicklin DJ, Ellis LM. Role of the vascular endothelial growth factor pathway in tumor growth and angiogenesis. J Clin Oncol 2005;23:1011–1027.

    Article  PubMed  CAS  Google Scholar 

  7. Jain RK, Duda DG, Clark JW, Loeffler JS. Lessons from phase III clinical trials on anti-VEGF therapy for cancer. Nature Clin Pract Oncol 2006;3:24–40.

    Article  CAS  Google Scholar 

  8. Saltz LB, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008;26:2013–2019.

    Article  PubMed  CAS  Google Scholar 

  9. Sanoff HK, Sargent DJ, Campbell ME, Morton RF, Fuchs CS, Ramanathan RK, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: n9741. J Clin Oncol 2008;26:5721–5727.

    Article  PubMed  CAS  Google Scholar 

  10. Ohtani H, Arimoto Y, Nishio K, Kanamiya Y, Oba H, Adachi K, et al. Efficacy and toxicity of fluorouracil, leucovorin plus oxaliplatin (FOLFOX4 and modified FOLFOX6) followed by fluorouracil, leucovorin plus irinotecan (FOLFIRI) for advanced or metastatic colorectal cancer-case studies. Gan To Kagaku Ryoho 2008;35:1769–1774.

    PubMed  CAS  Google Scholar 

  11. Matsumoto S, Nishimura T, Kanai M, Mori Y, Nagayama S, Kawamura J, et al. Safety and efficacy of modified FOLFOX6 for treatment of metastatic or locally advanced colorectal cancer. A single-institution outcome study. Chemotherapy 2008;54:395–403.

    Article  PubMed  CAS  Google Scholar 

  12. Rothenberg ML, Cox JV, Butts C, Navarro M, Bang YJ, Goel R, et al. Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol 2008;19:1720–1726.

    Article  PubMed  CAS  Google Scholar 

  13. Cassidy J, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 2008;26:2006–2012.

    Article  PubMed  CAS  Google Scholar 

  14. Omura K. Advances in chemotherapy against advanced or metastatic colorectal cancer. Digestion 2008;77:13–22.

    Article  PubMed  CAS  Google Scholar 

  15. Zhao JG, Qiu F, Xiong JP, Zhang L, Xiang XJ, Yu F. A phase II trial of modified FOLFOX as first-line chemotherapy in advanced colorectal cancer. Anticancer Drugs 2007;18:1103–1107.

    Article  Google Scholar 

  16. Liu YX, Jiang SJ, Kuang TH, Yao YW, Yang JW. Clinical observation of Yiqi Bushen Oral Liquid to the patients with carcinoma of large intestine’s metabasis and relapse after operation. Chin Arch Tradit Chin Med (Chin) 2007;25:1072–1073.

    Google Scholar 

  17. Li HJ, Dong L, Fu SY, Li Y. Comparative study on treatment of advanced colorectal cancer by Aidi Injection combined with FOLFOX4 regimen and by FOLFOX4 regimen alone. Chin J Integr Tradit West Med (Chin) 2007;27:1086–1089.

    Google Scholar 

  18. Ma J, Wang GH, Cai DF, Fan Y, Gu XX. Clinical observation of “Jianpi Xiaoliu Decoction” in preventing postoperative colorectal carcinoma recurrence and metastasis. Shanghai J Tradit Chin Med (Chin) 2005;39:24–25.

    Google Scholar 

  19. Liu J, Wang WP, Zhou YY, FANG ZY, HOU FG. Observation on therapeutic effect of Jianpi Huoxue herbs combined with chemotherapy in treating post-operational colonic cancer patients. Chin J Integr Tradit West Med (Chin) 2005;25:207–209.

    CAS  Google Scholar 

  20. Hu FS, Zhang Q, Wang XM, Yang GW, Zhao WS. Clinical study of Guben Xiaoliu Capsule combined with FOLFOX4 regimen in treating advanced colorectal cancer. Chin J Inf Tradit Chin Med (Chin) 2007;14 (7):13–14.

    Google Scholar 

  21. LI HS, LI HH, TANG ZJ. Effect of Chang’ai Kangfu Decoction on immunity in postoperational patients with large intestine cancer. Chin J Integr Tradit West Med (Chin) 2000;20:580–582.

    CAS  Google Scholar 

  22. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors: European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205–216.

    Article  PubMed  CAS  Google Scholar 

  23. Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, et al. CTCAE v3.0: development of a comperehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003;13:176–181.

    Article  PubMed  Google Scholar 

  24. Wang WP, Wang CJ. Traditional Chinese medicine for colorectal tumor metastasis understanding and countermeasures. Chin Arch Tradit Chin Med (Chin) 2002;(20):41–43.

  25. Jia XQ, Huang NJ, Qiu HZ. Colorectal cancer metastasis “stasis poison preach homes” pathogenesis of preliminary theoretical framework. Liaoning Tradit Chin Med (Chin) 2008;35:703–705.

    Google Scholar 

  26. Chi H, Kim DH, Ji GE. Transformation of ginsenosides Rb2 and Rc from Panax ginseng by food microorganisms. Biol Pharm Bull 2005;28:2102–2105.

    Article  PubMed  CAS  Google Scholar 

  27. Lee SJ, Sung JH, Lee SJ, Moon CK, Lee BH. Antitumor activity of a novel ginseng saponin metabolite in human pulmonary adenoeareinoma cells resistant to cisplatin. Cancer Lett 1999;144:39–43.

    Article  PubMed  CAS  Google Scholar 

  28. Choi HH, Jong HS, Park JH, Choi S, Lee JW, Kim TY. A novel ginseng saponin metabolite induces apoptosis and downregulates fibroblast growth factor receptor 3 in myeloma cells. Int J Oncol 2003;23:1087–1093.

    PubMed  CAS  Google Scholar 

  29. Wakabayashi C, MuraKami K, Hasegawa H. An intestinal bacterial metabolite of ginseng protopanaxadiol saponins has the ability to induce apoptosis in tumor cells. Biochem Biophys Res Comman 1998;246:725–730.

    Article  CAS  Google Scholar 

  30. Lee SJ, Ko WG, Kim JH, Sung JH, Moon CK, Lee BH. Induction of apoptosis by a novel intestinal metabolite of ginseng saponin via cytochrome c mediated activation of caspase-3 protease. Biochem Pharmacol 2000;60:677–685.

    Article  PubMed  CAS  Google Scholar 

  31. Zhan G, Feng LY. Effect of matrine on apoptosis and Bad expression of colorectal cancer cells in vitro. Chongqing Med (Chin) 2009;38:925–927.

    CAS  Google Scholar 

  32. Chen MW, Ni l, Zhao XG, Niu XY. Research of Ginseng saponins Rg3 inhibiting protein expression of tumor blood vessels growth control factor. Chin J Chin Mater Med (Chin) 2005;30:357–360.

    CAS  Google Scholar 

  33. Yue PY, Wong DY, Wu PK, Leung PY, Mak NK, Yeung HW, et al. The angiosuppressive effects of 20(R)-gineenoside Rg3. Biochem Pharmacol 2006;72:437–445.

    Article  PubMed  CAS  Google Scholar 

  34. Xu DJ, Chen MM. function and mechanism of Astragalus polysaccharides to inhibit tumor. Chin J Hospital Pharm (Chin) 2005;25:923–925.

    CAS  Google Scholar 

  35. Gu JC, Yu WB, Wang Y, Zhang ZT, Qu Z. Astragalus polysaccharide inhibits MA2981 growth and HSP70 expression on TA2 mice. Chin J Cancer Prev Treat (Chin) 2006;13:1534–1537.

    CAS  Google Scholar 

  36. Xu G, Huang W, Zhang WM, Lai ZS, He MR, Wang YD, et al. Effect of combined use of curcumin and catechin on cyclooxygenase-2 (COX-2) mRNA in dimethylhydrazine (DMH)-induced rat colon carcinogenesis. J First Milit Med Univ (Chin) 2005;25:48–52.

    Google Scholar 

  37. Zhang JR. The effect of curcumin on growth and apoptosis of human colon carcinoma cell in vitro. Chin Arch Tradit Chin Med (Chin) 2008,26:1284–1286.

    Google Scholar 

  38. Chen JX, Wang D, Wang J, Yu HB. Effects of Yiye Baijiang Zonggan Tablets on apoptosis of human colon cancer HT-29 cells. Chin J Hosp Pharm (Chin) 2007;27:159–161.

    CAS  Google Scholar 

  39. Yee C, Riddell SR, Greenberg PD. Prospects for adoptive T cell therapy. Curr Opin Immuno 1997;9:702–708.

    Article  CAS  Google Scholar 

Download references

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Correspondence to Shao-tang Li  (李绍堂).

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Cao, B., Li, St., Li, Z. et al. Yiqi Zhuyu Decoction (益气逐瘀汤) Combined with FOLFOX-4 as first-line therapy in metastatic colorectal cancer. Chin. J. Integr. Med. 17, 593–599 (2011). https://doi.org/10.1007/s11655-011-0822-z

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  • DOI: https://doi.org/10.1007/s11655-011-0822-z

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