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Consensus on the medical treatment of colon cancer

  • Consensus report
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memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Summary

PURPOSE: To throw light on some of the issues in the choice of therapy for patients with metastatic colorectal cancer (mCRC) and to provide consensus recommendations on which combination(s) and sequence(s) of systemic therapy to be used in different treatment situations. MATERIAL AND METHODS: An expert panel comprising clinicians from Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Romania, Slovakia, Slovenia, Spain and the UK with expertise in medical oncology, clinical oncology, surgery and dermatology, and specialist knowledge of the treatment of patients with CRC was convened by the Central European Cooperative Oncology Group (CECOG) in Vienna in 2007. Members were then asked to agree on a consensus statement following a period of discussion at the end of a series of presentations. RESULTS AND CONCLUSIONS: The consensus recommendations for the state-of-the-art treatment of colon cancer arrived at by an "expert panel" of clinicians were that: oral 5-fluorouracil (5-FU) prodrugs or protracted intravenous infusion of the antimetabolite are preferable to bolus administration; all active drugs (fluoropyrimidines, irinotecan, oxaliplatin, bevacizumab, cetuximab) should be used during strategic patient management; after neoadjuvant treatment and consultation of an interdisciplinary team, surgery should be considered for metastatic disease wherever possible and "fit" elderly patients should not be denied the same treatment as younger patients.

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References

  • Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin, 55: 74–108, 2005

    PubMed  Google Scholar 

  • André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 350: 2343–2351, 2004

    Article  PubMed  Google Scholar 

  • André T, Tournigand C, Achille E, et al. Adjuvant treatment of colon cancer MOSAIC study's main results. Bull Cancer, 93 (Suppl 1): S5–S9, 2006

    PubMed  Google Scholar 

  • Kerr DJ, Gray R, McConkey C, et al. Adjuvant chemotherapy with 5-fluorouracil, L-folinic acid and levamisole for patients with colorectal cancer: non-randomised comparison of weekly versus four-weekly schedules-less pain, same gain. QUASAR Colorectal Cancer Study Group. Ann Oncol, 11: 947–955, 2000

    Article  PubMed  CAS  Google Scholar 

  • O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst, 96: 1420–1425, 2004

    PubMed  Google Scholar 

  • Thirion P, Michiels S, Pignon JP, et al. Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: an updated meta-analysis. J Clin Oncol, 22: 3766–3775, 2004

    Article  PubMed  CAS  Google Scholar 

  • de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol, 18: 2938–2947, 2000

    PubMed  CAS  Google Scholar 

  • Giacchetti S, Perpoint B, Zidani R, et al. Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer. J Clin Oncol, 18: 136–147, 2000

    PubMed  CAS  Google Scholar 

  • Köhne CH, van Cutsem E, Wils J, et al. Phase III study of weekly high-dose infusional fluorouracil plus folinic acid with or without irinotecan in patients with metastatic colorectal cancer: European Organisation for Research and Treatment of Cancer Gastrointestinal Group Study 40986. J Clin Oncol, 23: 4856–4865, 2005

    Article  PubMed  CAS  Google Scholar 

  • Saltz LB, Cox JV, Blanke C, et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med, 343: 905–914, 2000

    Article  PubMed  CAS  Google Scholar 

  • Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet, 355: 1041–1047, 2000

    Article  PubMed  CAS  Google Scholar 

  • Tournigand C, Andre T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol, 22: 229–237, 2004

    Article  PubMed  CAS  Google Scholar 

  • Nordlinger B, Van Cutsem E, Rougier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group. Eur J Cancer, 42: 2037–2045, 2007

    Article  CAS  Google Scholar 

  • Van Cutsem E, Nordlinger B, Adam R, et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer, 42: 2212–2221, 2006

    Article  PubMed  Google Scholar 

  • Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. J Clin Oncol, 17: 1356–1363, 1999

  • Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol, 22: 1797–1806, 2004

    Article  PubMed  CAS  Google Scholar 

  • Iwashyna TJ, Lamont EB. Effectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer. J Clin Oncol, 20: 3992–3998, 2002

    Article  PubMed  CAS  Google Scholar 

  • Moertel CG, Fleming TR, Macdonald JS, et al. Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med, 122: 321–326, 1995

    PubMed  CAS  Google Scholar 

  • Arkenau HT, Bermann A, Rettig K, et al. 5-Fluorouracil plus leucovorin is an effective adjuvant chemotherapy in curatively resected stage III colon cancer: long-term follow-up results of the adjCCA-01 trial. Ann Oncol, 14: 395–399, 2003

    Article  PubMed  CAS  Google Scholar 

  • Grothey A, Sargent DJ. FOLFOX for stage II colon cancer? A commentary on the recent FDA approval of oxaliplatin for adjuvant therapy of stage III colon cancer. J Clin Oncol, 23: 3311–3313, 2005

    Article  PubMed  Google Scholar 

  • Scheithauer W, McKendrick J, Begbie S, et al. Oral capecitabine as an alternative to i.v. 5-fluorouracil-based adjuvant therapy for colon cancer: safety results of a randomized, phase III trial. Ann Oncol, 14: 1735–1743, 2003

    Article  PubMed  CAS  Google Scholar 

  • Carrato A, Köhne C, Bedenne L, et al. Folinic acid modulated bolus 5-FU or infusional 5-FU for adjuvant treatment of patients of UICC stage III colon cancer: preliminary analysis of the PETACC-2-study. J Clin Oncol, 24: 18S, 2006 (abstr 3563)

    Article  Google Scholar 

  • Chau I, Norman AR, Cunningham D, et al. A randomised comparison between 6 months of bolus fluorouracil/leucovorin and 12 weeks of protracted venous infusion fluorouracil as adjuvant treatment in colorectal cancer. Ann Oncol, 16: 549–557, 2005

    Article  PubMed  CAS  Google Scholar 

  • Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med, 352: 2696–2704, 2005

    Article  PubMed  CAS  Google Scholar 

  • Cassidy J, Douillard JY, Twelves C, et al. Pharmacoeconomic analysis of adjuvant oral capecitabine vs intravenous 5-FU/LV in Dukes' C colon cancer: the X-ACT trial. Br J Cancer, 94: 1122–1129, 2006

    Article  PubMed  CAS  Google Scholar 

  • Twelves C, Scheithauer W, McKendrick J, et al. Capecitabine versus 5-FU/LV in stage lll colon cancer: updated 5-year efficacy data from X-ACT trial and preliminary analysis of relationship between hand-foot syndrome (HFS) and efficacy. ASCO Gastrointestinal Cancers Symposium, 2008 (abstr 274)

  • Van Cutsem E, Labianca R, Hossfeld D, et al. Randomized phase III trial comparing infused irinotecan/5-fluorouracil (5-FU)/folinic acid (IF) versus 5-FU/FA (F) in stage III colon cancer patients (pts). (PETACC 3). J Clin Oncol, 23: 16S, 2005 (abstr LBA8)

    Google Scholar 

  • Wolmark N. Provocative optimism in the treatment of early stage disease. Oncologist, 10 (Suppl 2) 1–3, 2005

    Article  PubMed  Google Scholar 

  • de Gramont A, Boni C, Navarro M, et al. Oxaliplatin/5FU/LV in adjuvant colon cancer: updated efficacy results of the MOSAIC trial, including survival, with a median follow-up of six years. J Clin Oncol, 25: 18S, 2007 (abstr 4007)

    Article  CAS  Google Scholar 

  • Saltz LB, Niedzwiecki D, Hollis D, et al. Irinotecan fluorouracil plus leucovorin is not superior to fluorouracil plus leucovorin alone as adjuvant treatment for stage III colon cancer: results of CALGB 89803. J Clin Oncol, 25: 3456–3461, 2007

    Article  PubMed  CAS  Google Scholar 

  • Ychou M, Raoul J, Douillard J, et al. A phase III randomized trial of LV5FU2+CPT-11 vs LV5FU2 alone in adjuvant high risk colon cancer (FNCLCC Accord02/FFCD9802). J Clin Oncol, 23: 16S, 2005 (abstr 3502)

    Google Scholar 

  • Gray R, Barnwell J, Hills R, et al. QUASAR: a randomized study of adjuvant chemotherapy (CT) vs observation including 3238 colorectal cancer patients. J Clin Oncol, 22: 14S, 2004 (abstr 3501)

    Google Scholar 

  • Quasar Collaborative G, Gray R, Barnwell J, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet, 370: 2020–2029, 2007

    Article  PubMed  Google Scholar 

  • Schmoll HJ, Tabernero J, Nowacki M, et al. Final safety findings from a randomized phase III trial of capecitabine + oxaliplatin (XELOX) vs. bolus 5-FU/LV as adjuvant therapy for patients (pts) with stage III colon cancer. J Clin Oncol, 24: 18S, 2006 (abstr 3569)

    Article  Google Scholar 

  • Green E, Sargent D, Goldberg R, et al. Detailed analysis of oxaliplatin-association neurotoxicity in Intergroup trial N9741. ASCO GI Cancers Symposium, 2005 (abstr 182)

  • Tournigand C, Cervantes A, Figer A, et al. OPTIMOX1: a randomized study of FOLFOX4 or FOLFOX7 with oxaliplatin in a stop-and-go fashion in advanced colorectal cancer – a GERCOR study. J Clin Oncol, 24: 394–400, 2006

    Article  PubMed  CAS  Google Scholar 

  • Maindrault-Goebel F, Lledo G, Chibaudel B, et al. Final results of OPTIMOX2, a large randomized phase II study of maintenance therapy or chemotherapy – free intervals (CFI) after FOLFOX in patients with metastatic colorectal cancer (MRC): A GERCOR study. J Clin Oncol, 25: 18S, 2007 (abstr 4013)

    Google Scholar 

  • 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, 23: 9441–9442, 2005

    Article  PubMed  Google Scholar 

  • Grothey A, Sargent D, Goldberg RM, et al. 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, 2004

    Article  PubMed  CAS  Google Scholar 

  • Seymour MT, Maughan TS, Ledermann JA, et al. Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial. Lancet, 370: 143–152, 2007

    Article  PubMed  CAS  Google Scholar 

  • Hurwitz H, Kabbinavar F. Bevacizumab combined with standard fluoropyrimidine-based chemotherapy regimens to treat colorectal cancer. Oncology, 69 (Suppl 3): 17–24, 2005

    Article  PubMed  CAS  Google Scholar 

  • Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med, 350: 2335–2342, 2004

    Article  PubMed  CAS  Google Scholar 

  • Saltz L, Clarke S, Diaz-Rubio E, et al. Bevacizumab (Bev) in combination with XELOX or FOLFOX4: updated efficacy results from XELOX-1/NO16966, a randomized phase III trial in first-line metastatic colorectal cancer. J Clin Oncol, 25: 18S, 2007 (abstr 4028)

    Google Scholar 

  • Giantonio BJ, Catalano PJ, Meropol NJ, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol, 25: 1539–1544, 2007

    Article  PubMed  CAS  Google Scholar 

  • Dittrich C, Hoehler T, Lordick F, et al. A phase l/ll study of cetuximab in combination with 5-fluorouracil (5-FU)/folinic acid (FA) plus weekly oxaliplatin (L-OHP) (FUFOX) in the first-line treatment of patients with metastatic colorectal cancer (mCRC) expressing epidermal growth factor receptor (EGFR). Preliminary results. Ann Oncol, 17 (Suppl 6), 2006 (abstr O-019)

  • Folprecht G, Lutz MP, Schoffski P, et al. Cetuximab and irinotecan/5-fluorouracil/folinic acid is a safe combination for the first-line treatment of patients with epidermal growth factor receptor expressing metastatic colorectal carcinoma. Ann Oncol, 17: 450–456, 2006

    Article  PubMed  CAS  Google Scholar 

  • Peeters M, Raoul J, Van Laethem J-L, et al. Cetuximab in combination with irinotecan/5-fluorouracil (5-FU)/folinic acid (FA)(FOLFIRI) in the first-line treatment of metastatic colorectal cancer (mCRC). Eur J Cancer Suppl, 3: 2, 2005 (abstr 664)

    Google Scholar 

  • Rosenberg AH, Loehrer PJ, Needle MN, et al. Erbitux (IMC-C225) plus weekly irinotecan (CPT-11), fluorouracil (5FU) and leucovorin (LV) in colorectal cancer (CRC) that expresses the epidermal growth factor receptor (EGFr). Proc Am Soc Clin Oncol, 21, 2002 (abstract 536)

  • Bokemeyer C, Staroslawska E, Makhson A, et al. Cetuximab plus 5FU/FA/oxaliplatin (FOLFOX4) in the first-line treatment of metastastic colorectal cancer (mCRC): a large-scale phase II study, OPUS. Eur J Cancer Suppl, 5: 4, 2007 (abstr O3004)

    Article  Google Scholar 

  • Van Cutsem E, Bodoky G, Kyung Roh J, et al. CRYSTAL, a randomized phase III trial of cetuximab plus FOLFIRI vs. FOLFIRI in first-line metastatic colorectal cancer (mCRC). Eur J Cancer Suppl, 5: 4, 2007 (abstr O3001)

    Google Scholar 

  • Tabernero J, Cervantes A, Ciardiello F, et al. Correlation of efficacy to KRAS status (wt vs. mut) in patients (pts) with metastatic colorectal cancer (mCRC), treated with weekly (q1w) and q2w schedules of cetuximab combined with FOLFIRI. ASCO Gastrointestinal Cancers Symposium, 2008 (abstr 435)

  • Saltz L, Rubin M, Hochster HS, et al. Cetuximab (IMC-C225) plus irinotecan (CPT-11) is active in CPT-11 refractory colorectal cancer (CRC) that expresses epidermal growth factor receptor (EGFR). Proc Am Soc Clin Oncol, 20, 2001 (abstr 7)

  • Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med, 351: 337–345, 2004

    Article  PubMed  CAS  Google Scholar 

  • Wilke H, Glynne-Jones R, Thaler J, et al. MABEL-A large multinational study of cetuximab plus irinotecan in irinotecan resistant metastatic colorectal cancer. J Clin Oncol, 24: 18S, 2006 (abstr 3549)

    Article  Google Scholar 

  • Sobrero A, Maurel J, Fehrenbacher L, et al. EPIC: Phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 26: e-pub, 2008

  • Eng C, Maurel J, Scheithauer W, et al. Impact on quality of life of adding cetuximab to irinotecan in patients who have failed prior oxaliplatin-based therapy: the EPIC trial. J Clin Oncol, 25: 18S, 2007 (abstr 4003)

    Google Scholar 

  • Au H, Karapetis C, Jonker D, et al. Quality of life in patients with advanced colorectal cancer treated with cetuximab: results of the NCIC CTG and AGITG CO.17 trial. J Clin Oncol, 25: 18S, 2007 (abstr 4002)

    Google Scholar 

  • Amado RG, Wolf M, Freeman D, et al. Panitumumab (pmab) efficacy and patient-reported outcomes (PRO) in metastatic colorectal cancer (mCRC) patients (pts) with wild-type (WT) KRAS tumour status. ASCO Gastrointestinal Cancers Symposium, 2008 (abstr 278)

  • Amado RG, Wolf M, Peeters M, et al. Wild-type KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer. J Clin Oncol, 26: 1626–1634, 2008

    Article  PubMed  CAS  Google Scholar 

  • Hecht J, Chidiac T, Mitchell E, et al. An interim analysis of efficacy and safety from a randomized controlled trial of panitumumab with chemotherapy plus bevacizumab (Bev) in metastatic colorectal cancer (mCRC). Ann Oncol, 18: Suppl 7, 2007 (abstr O-0033)

  • Falcone A, Ricci S, Brunetti I, et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol, 25: 1670–1676, 2007

    Article  PubMed  CAS  Google Scholar 

  • Souglakos J, Androulakis N, Syrigos K, et al. FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan) vs FOLFIRI (folinic acid, 5-fluorouracil and irinotecan) as first-line treatment in metastatic colorectal cancer (MCC): a multicentre randomised phase III trial from the Hellenic Oncology Research Group (HORG). Br J Cancer, 94: 798–805, 2006

    Article  PubMed  CAS  Google Scholar 

  • Punt CJ, Koopman M, Douma J, et al. Sequential compared to combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (ACC): A Dutch Colorectal Cancer Group (DCCG) phase III study. J Clin Oncol, 25: 18S, 2007 (abstract 4012)

    Google Scholar 

  • Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases. Ann Oncol, 14 (Suppl 2): ii13–ii16, 2003

    PubMed  Google Scholar 

  • Bismuth H, Adam R, Levi F, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg, 224: 509–520, 1996

    Article  PubMed  CAS  Google Scholar 

  • Folprecht G, Grothey A, Alberts S, et al. Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol, 16: 1311–1319, 2005

    Article  PubMed  CAS  Google Scholar 

  • Giacchetti S, Itzhaki M, Gruia G, et al. Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol, 10: 663–669, 1999

    Article  PubMed  CAS  Google Scholar 

  • Cervantes A, Cassado E, Van Custem E, et al. Phase II study with cetuximab plus FOLFOX-4 in first-line setting for epidermal growth factor receptor (EGFR)-expressing metastatic colorectal cancer (mCRC). Eur J Cancer Suppl, 3: 2, 2005 (abstr 642)

    Google Scholar 

  • Fisher GA, Kuo T, Cho D, et al. A phase II study of gefitinib in combination with FOLFOX-4 (IFOX) in patients with metastatic colorectal cancer. J Clin Oncol, 22: 14S, 2004 (abstr 3514)

    Article  CAS  Google Scholar 

  • Kopetz S, Abbruzzese JL, Eng C, et al. Preliminary results from a phase II study of infusional 5-FU, leucovorin and irinotecan (FOLFIRI) plus bevacizumab as first-line treatment for metastatic colorectal cancer (mCRC). J Clin Oncol, 24: 18S, 2006 (abstr 3579)

    Article  Google Scholar 

  • Abad A, Anton A, Massuti B, et al. Resectability of liver metastases (LM) in patients with advanced colorectal cancer (ACRC) after treatment with the combination of oxaliplatin (OXA), irinotecan (IRI) and 5-FU: final results of a phase II study. J Clin Oncol, 23: 16S, 2005 (abstr 3618)

    Google Scholar 

  • Quenet F, Nordlinger B, Rivoire M, et al. Resection of previously unresectable liver metastases from colorectal cancer after chemotherapy with CPT-11/L-OHP/LV5FU (Folfirinox): a propsective phase II trial. J Clin Oncol, 22: 14S, 2004 (abstr 3613)

    Google Scholar 

  • Seium Y, Stupp R, Ruhstaller T, et al. Oxaliplatin combined with irinotecan and 5-fluorouracil/leucovorin (OCFL) in metastatic colorectal cancer: a phase I-II study. Ann Oncol, 16: 762–766, 2005

    Article  PubMed  CAS  Google Scholar 

  • Watkins DJ, Jackson C, Chua Y, et al. A prospective study of oxaliplatin and capecitabine (CapOx) in metastatic colorectal cancer (MCRC) with baseline stratification according to resectability status. J Clin Oncol, 25: 14S, 2007 (abstr 4024)

    Article  Google Scholar 

  • Fernandez FG, Ritter J, Goodwin JW, et al. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg, 200: 845–853, 2005

    Article  PubMed  Google Scholar 

  • Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg, 243: 1–7, 2006

    Article  PubMed  Google Scholar 

  • Rubbia-Brandt L, Mentha G, Terris B. Sinusoidal obstruction syndrome is a major feature of hepatic lesions associated with oxaliplatin neoadjuvant chemotherapy for liver colorectal metastases. J Am Coll Surg, 202: 199–200, 2006

    Article  PubMed  Google Scholar 

  • Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol, 24: 2065–2072, 2006

    Article  PubMed  CAS  Google Scholar 

  • Nordlinger B, Sorbye H, Collette L, et al. Final results of the EORTC Intergroup randomized phase III study 40983 [EPOC] evaluating the benefit of peri-operative FOLFOX4 chemotherapy for patients with potentially resectable colorectal cancer liver metastases. J Clin Oncol, 25: 18S, 2007 (LBA5)

    Google Scholar 

  • Ellis LM, Curley SA, Grothey A. Surgical resection after downsizing of colorectal liver metastasis in the era of bevacizumab. J Clin Oncol, 23: 4853–4855, 2005

    Article  PubMed  CAS  Google Scholar 

  • Gruenberger B, Scheithauer W, Tamandl D, et al. Neoadjuvant bevacizumab plus XELOX is feasible in patients with potentially curable metastatic colorectal cancer receiving synchronous resection. Eur J Cancer Suppl, 5: 4, 2007 (abstr 3064)

    Article  Google Scholar 

  • Gruenberger T, Tamandl D, Puhalla H, et al. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol, 25: 18S, 2007 (abstr 4064)

    Google Scholar 

  • Berry SR, Van Cutsem E, Kretzschmar A, et al. Preliminary efficacy of bevacizumab with first-line FOLFOX, XELOX, FOLFIRI, and fluoropyrimidines for mCRC: first BEAT. ASCO Gastrointestinal Cancers Symposium, 2008 (abstr 350)

  • Cunningham D, Kretzschmar A, Berry S, et al. Efficacy and safety of surgery with curative intent in patients treated with first-line bevacizumab for mCRC: first BEAT. ASCO Gastrointestinal Cancers Symposium, 2008 (abstr 445)

  • Kesmodel SB, Ellis LM, Lin E, et al. Complication rates following hepatic surgery in patients receiving neoadjuvant bevacizumab (BV) for colorectal cancer (CRC) liver metastases. ASCO Gastrointestinal Cancers Symposium, 2007 (abstr 234)

  • Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet, 356: 968–974, 2000

  • Biganzoli L, Aapro M. Adjuvant chemotherapy in the elderly. Ann Oncol, 14 (Suppl 3): iii1–iii3, 2003

    PubMed  Google Scholar 

  • Neugut AI, Matasar M, Wang X, et al. Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol, 24: 2368–2375, 2006

    Article  PubMed  CAS  Google Scholar 

  • Potosky AL, Harlan LC, Kaplan RS, et al. Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol, 20: 1192–1202, 2002

    Article  PubMed  Google Scholar 

  • Schrag D, Cramer LD, Bach PB, et al. Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst, 93: 850–857, 2001

    Article  PubMed  CAS  Google Scholar 

  • Sundararajan V, Mitra N, Jacobson JS, et al. Survival associated with 5-fluorouracil-based adjuvant chemotherapy among elderly patients with node-positive colon cancer. Ann Intern Med, 136: 349–357, 2002

    PubMed  CAS  Google Scholar 

  • Damhuis RA, Wereldsma JC, Wiggers T. The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer. Int J Colorectal Dis, 11: 45–48, 1996

    PubMed  CAS  Google Scholar 

  • Folprecht G, Seymour MT, Saltz LB, et al. Irinotecan/5-fluorouracil combinations in the first-line therapy of older and younger patients with metastatic colorectal cancer: combined analysis of patients in randomized controlled trials. J Clin Oncol, 26: 1443–1451, 2008

    Article  PubMed  CAS  Google Scholar 

  • Goldberg RM, Tabah-Fisch I, Bleiberg H, et al. Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol, 24: 4085–4091, 2006

    Article  PubMed  CAS  Google Scholar 

  • Arkenau H, Englisch-Fritz C, Kubicka S, et al. Oxaliplatin in combination with capecitabine or 5-fluorouracil/leucovorin in elderly patients (>70 yrs) with metastatic colorectal cancer (MCRC). ASCO Gastrointestinal Cancers Symposium, 2007 (abstr 283)

  • Viret F, Bugat R, Ducreux M, et al. XELOX regimen in elderly patients with metastatic colorectal cancer (MCRC), a FNCLCC French Collaborative Group GERICO 02 phase II study. J Clin Oncol, 25: 18S, 2007 (abstr 19513)

    Google Scholar 

  • Barrueco J, Marshall J, Mitchell E, et al. Safety and efficacy of first-line irinotecan/fluoropymidine combinations in mCRC patients > 65 years compared with those < 65: The BICC-C study. J Clin Oncol, 25: 18S, 2007 (abstr 4076)

    Google Scholar 

  • Ho C, O'Reilly S, Ng K, et al. Population-based analysis of patients with advanced colorectal cancer: the impact of age on treatment and outcomes. J Clin Oncol, 23: 16S, 2005 (abstr 3614)

    Article  Google Scholar 

  • Starling N, Cunningham D. Does shorter duration of chemotherapy worsen survival for elderly patients with colon cancer? Nat Clin Pract Oncol, 4: 12–13, 2007

    Article  PubMed  Google Scholar 

  • Dobie SA, Baldwin LM, Dominitz JA et al. Completion of therapy by Medicare patients with stage III colon cancer. J Natl Cancer Inst, 98: 610–619, 2006

    Article  PubMed  Google Scholar 

  • Mitry E, Douillard JY, Van Custem E, et al. Predictive factors of survival in patients with advanced CRC: an individual data analysis of 602 patients included in irinotecan phase III trials. Ann Oncol, 15: 1013–1017, 2004

    Article  PubMed  CAS  Google Scholar 

  • Goldberg R, C.H. K, Seymour M, et al. A pooled safety and efficacy analysis examining the effect of performance status (PS) on outcomes in nine first-line treatment (rx) trials (cts) of 6286 patients (pts) with metastatic colorectal cancer (MCRC). J Clin Oncol, 25: 18S, 2007 (abstr 4011)

    Article  Google Scholar 

  • Mattioli R, Massacesi C, Recchia F, et al. High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer. Ann Oncol, 16: 1147–1151, 2005

    Article  PubMed  CAS  Google Scholar 

  • Oh D, Kim Y, Han S, et al. Efficacy of reduced dose intensity FOLFOX-4 as first line palliative chemotherapy in elderly patients with advanced colorectal cancer (CRC). J Clin Oncol, 23: 16S, 2005 (abstr 3720)

    Article  Google Scholar 

  • Twelves CJ, Butts CA, Cassidy J, et al. Capecitabine/oxaliplatin, a safe and active first-line regimen for older patients with metastatic colorectal cancer: post hoc analysis of a large phase II study. Clin Colorectal Cancer, 5: 101–107, 2005

    Article  PubMed  Google Scholar 

  • Sastre J, Marcuello E, Masutti B, et al. Irinotecan in combination with fluorouracil in a 48-hour continuous infusion as first-line chemotherapy for elderly patients with metastatic colorectal cancer: a Spanish Cooperative Group for the Treatment of Digestive Tumours study. J Clin Oncol, 23: 3545–3551, 2005

    Article  PubMed  CAS  Google Scholar 

  • Souglakos J, Pallis A, Kakolyris S, et al. Combination of irinotecan (CPT-11) plus 5-fluorouracil and leucovorin (FOLFIRI regimen) as first line treatment for elderly patients with metastatic colorectal cancer: a phase II trial. Oncology, 69: 384–390, 2005

    Article  PubMed  CAS  Google Scholar 

  • Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet, 345: 939–944, 1995

  • Punt CJ, Nagy A, Douillard JY, et al. Edrecolomab alone or in combination with fluorouracil and folinic acid in the adjuvant treatment of stage III colon cancer: a randomised study. Lancet, 360: 671–677, 2002

    Article  PubMed  CAS  Google Scholar 

  • Fields AL, Keller AM, Schwartzberg L, et al. Edrecolomab (17-1A antibody) (DER) in combination with 5-fluorouracil (FU) based chemotherapy in the adjuvant treatment of stage III colon cancer. Results of a randomized North American phase III study. Proc Am Soc Clin Oncol, 21: 128a, 2002 (abstr 508)

    Google Scholar 

  • Andre T, Colin P, Louvet C, et al. Semimonthly versus monthly regimen of fluorouracil and leucovorin administered for 24 or 36 weeks as adjuvant therapy in stage II and III colon cancer: results of a randomized trial. J Clin Oncol, 21: 2896–2903, 2003

    Article  PubMed  CAS  Google Scholar 

  • Grothey A, Deschler B, Kroening H, et al. Phase III study of bolus 5-fluorouracil (5-FU)/folinic acid (FA) (Mayo) vs weekly high-dose 24h 5-FU infusion/FA + oxaliplatin (OXA) (FUFOX) in advanced colorectal cancer (ACRC). Proc Am Soc Clin Oncol, 21, 2002 (abstr 512)

  • Pluzanska A, Mainwaring P, Cassidy J, et al. Final results of a randomized phase III study evaluting the addition of oxaliplatin first-line to 5-FU followed bu irinotecan at progression in advanced colorectal cancer (LIFE study). J Clin Oncol, 23: 16S, 2005 (abstr 3517)

    Google Scholar 

  • Hospers GA, Schaapveld M, Nortier JW, et al. Randomised Phase III study of biweekly 24-h infusion of high-dose 5FU with folinic acid and oxaliplatin versus monthly plus 5-FU/folinic acid in first-line treatment of advanced colorectal cancer. Ann Oncol, 17: 443–449, 2006

    Article  PubMed  CAS  Google Scholar 

  • Goldberg RM, Sargent DJ, Morant RS, 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, 22: 23–30, 2004

    Article  PubMed  CAS  Google Scholar 

  • Venook AP, Niedzwiecki D, Hollis D, et al. Phase III study of irinotecan/5FU/LV (FOLFIRI) or oxaliplatin/5FU/LV (FOLFOX) ± cetuximab for patients (pts) with untreated metastatic adenocarcinoma of the colon or rectum (MCRC): CALGB 80203 preliminary results. J Clin Oncol, 24: 18S, 2006 (abstr 3509)

    Article  Google Scholar 

  • Borner M, Mingrone W, Koeberle D, et al. The impact of cetuximab on the capecitabine plus oxaliplatin (XELOX) combination in first-line treatment of metastatic colorectal cancer (MCC): a randomized phase II trial of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol, 24: 18S, 2006 (abstr 3551)

    Article  Google Scholar 

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Authors and Affiliations

  1. Clinical Division of Oncology, Department of Medicine I, University Hospital, Medical University of Vienna, Vienna, Austria

    G. Kornek & W. Scheithauer

  2. Institutul Oncologic Bucurest, Bucuresti, Romania

    R. Anghel

  3. Fovárosi Szent László és Szent István Kórház, Onkológiai Osztály, Budapest, Hungary

    G. Bodoky

  4. Cattedra di Oncologia Medica, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi e A. Lanzara", Seconda Università degli Studi di Napoli, Naples, Italy

    F. Ciardiello

  5. Institutul Oncologic Clu, Cluj-Napoca, Romania

    T. Ciuleanu

  6. Mount Vernon Cancer Centre, Macmillan Lead Clinician in Gastro-Intestinal Cancer, Northwood, Middlesex, UK

    R. Glynne-Jones

  7. Department of General Surgery, University Hospital, Medical University of Vienna, Vienna, Austria

    T. Gruenberger

  8. National Cancer Institute, Bratislava, Slovak Republic

    I. Koza

  9. Institute of Oncolog, Ljubljana, Slovenia

    J. Ocvirk

  10. Department of Oncology, Charles University Prague, Prague, Czech Republic

    L. Petruzelka

  11. University Hospital Aintree, Liverpool, UK

    G. Poston

  12. Abt. Gastroenterologie und Endokrinologie, Universität Göttingen – Bereich Humanmedizin, Göttingen, Germany

    G. Ramadori

  13. Medizinische Universitätsklinik, Ruhr-Universität Bochum, Bochum, Germany

    W. Schmiegel

  14. Department of Dermatology, University Hospital Sint-Rafaël, Leuven, Belgium

    S. Segaert

  15. Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain

    J. Tabernero

  16. Univ. Klin. Innsbruck, Onkologie, Innsbruck, Austria

    H. Zwierzina

  17. Department of Internal Medicine I and Cancer Center, Medical University of Vienna, Vienna, Austria

    C. Zielinski

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  1. G. Kornek
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  2. W. Scheithauer
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  3. R. Anghel
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  4. G. Bodoky
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  5. F. Ciardiello
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  6. T. Ciuleanu
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  8. T. Gruenberger
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  9. I. Koza
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  10. J. Ocvirk
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  11. L. Petruzelka
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  12. G. Poston
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  13. G. Ramadori
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  14. W. Schmiegel
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  15. S. Segaert
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  16. J. Tabernero
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  17. H. Zwierzina
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  18. C. Zielinski
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Corresponding author

Correspondence to C. Zielinski.

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Kornek, G., Scheithauer, W., Anghel, R. et al. Consensus on the medical treatment of colon cancer. memo 1, 79–90 (2008). https://doi.org/10.1007/s12254-008-0036-2

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  • DOI: https://doi.org/10.1007/s12254-008-0036-2

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