Abstract
Background and Aims: Treatment of metastatic colorectal cancer with new drugs (NDs) as oxaliplatin and irinotecan had improved response and survival. In order to check whether the promising achievements of the trials are obtained in routine clinical practice, we have reviewed retrospectively our results for two periods, before (period A: 1993–1995, n=63) and after (period B: 1998–2000 n=103) the introduction of these NDs. Patients characteristics, treatment modalities, survival, and prognostic factors were compared.
Patients: There were 74 women and 92 men, aged 60.8 ±11.6 yr, 7 patients received best supportive care only, 91 had synchronous metastasis.
Results: Period B patients were older, with WHO score >1 more often, more adjuvant treatment, more metachronous metastasis, and NDs used more frequently (24% vs 59%). Median survival was similar (16 vs 15 mo). But when looking at the population aged <75 years with WHO score <2, median survival was 13 mo (period A) vs 21 mo (period B); survival at 1,2, and 3 yr were respectively 59.5±8%, 16.2±6%, 13.5±6% vs 69.8±6%, 49.6±7%, 29.8±7%, p<0.01). In multiparametric analysis, factors correlated with survival were the absence of elevated serum alkaline phosphatase, a unique metastatic organ, and administration of NDs.
Conclusion: In our routine clinical experience the use of NDs for metastatic CRC has allowed a significant improvement in survival among patients with unresectable tumors.
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References
Advanced Colorectal Cancer Meta-analysis Project. Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response. J Clin Oncol 1992;10:896–903.
Cunigham D, Pyrhonen S, James RD, et al. Randomized trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 1998;352:1413–1418.
Cunnigham D. Mature results from three large controlled studies with raltitrexed (“Tomudex”). Br J Cancer 1998;77(Suppl 2):15–21.
Levi F, Perpoint B, Garufi C, Focan C, Chollet P, Depres-Brummer P. Oxaliplatin activity against metastatic colorectal cancer: a phase II study of 5-day continuous infusion at circadian rhythm modulated rate. Eur J Cancer 1993;29:1280–1284.
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 2000;18:2938–2947.
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 2000;355:1041–1047.
Scheithauer W, Rosen H, Kornek GV, Sebesta C, Depisch B. Randomized comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ 1993;306:752–755.
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 2004;22:229–237.
de Gramont A, Bosset JF, Milan C, et al. Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with bimonthly high-dose leucovorin and fluorouracil bolus plus continuous infusion for advanced colorectal cancer: a French Intergroup Study. J Clin Oncol 1997;15:808–815.
Gamelin E, Boisdron-Celle M, Delva R, et al. Long-term weekly treatment of colorectal metastatic cancer with fluorouracil and leucovorin: results of a multicentric prospective trial of fluorouracil dosage optimization by pharmacokinetic monitoring in 152 patients. J Clin Oncol 1998;16:1470–1478.
Lokich JJ, Ahlgren JD, Gullo JJ, Philips JA, Fryer JG. A prospective randomized comparison of continuous infusion fluorouracil with a conventional bolus schedule in metastatic colorectal carcinoma: a Mid-Atlantic Oncology Program Study. J Clin Oncol 1989;7:425–432.
Jamieson RL, Donohue JH, Nagorney DM, Rosen CB, Harmsen WS, Ilstrup DM. Hepatic resections for metastatic colorectal cancer. Results in cure for some patients. Arch Surg 1997;132:505–511.
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, lecovorin, oxaliplatin and surgery. Ann Oncol 1999;10:663–669.
Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastasis from colorectal cancers. Ann Surg 2000;231:487–499.
Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases. Ann Oncol 2003;14(Suppl 2):13–16.
Penna C, Nordlinger B. Surgery of liver metastasis from colorectal cancer: new promises. Br M ed Bull 2002;64:127–140.
Topham C, Adam R. Oncosurgery: a new reality in metastatic colorectal carcinoma. Semin Oncol 2002;29(Suppl 15):3–10.
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Egreteau, J., Boucher, E., de Guibert, S. et al. New drugs for colorectal cancer (irinotecan, oxaliplatin, raltitrexed) meet expectations in routine practice. Int J Gastrointest Canc 35, 69–76 (2005). https://doi.org/10.1385/IJGC:35:1:069
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DOI: https://doi.org/10.1385/IJGC:35:1:069