A Retrospective Study of First-Line Combination Chemotherapy in Advanced Colorectal Cancer: A Korean Single-Center Experience

다국어 초록 (Multilingual Abstract)

Purpose Fluoropyrimidine-based combination chemotherapy, in combination with either oxaliplatin or irinotecan, has demonstrated efficacy and tolerability in treatment of advanced colorectal cancer (ACC).
Materials and Methods Between January 2006 and December 2007, a total of 478 ACC patients were treated with combination chemotherapy in first-line settings. Combination therapies included: 5-fluorouracil,folinic acid plus oxaliplatin (FOLFOX, n=172), 5-fluorouracil, folinic acid plus irinotecan (FOLFIRI, n=95), capecitabine plus oxaliplatin (XELOX, n=155), and capecitabine plus irinotecan (XELIRI, n=56). FOLFOX and FOLFIRI were repeated every 2 weeks, whereas XELOX and XELIRI were repeated every 3 weeks until occurrence of disease progression or unacceptable toxicity, or until a patient chose to discontinue treatment.
Results The median age was 58 years (range, 19 to 84 years) and the median chemotherapy durations for FOLFOX, FOLFIRI, XELOX, and XELIRI were 4.9, 4.5, 5.7, and 5.4 months,respectively. Combination chemotherapy regimens were generally well tolerated. The estimated median progression-free-survival (PFS) for all patients was 6.8 months (95%confidence interval, 6.3 to 7.3 months). No statistically significant difference in PFS was found among regimens used as first-line chemotherapy. Sixty percent (n=290) of patients received second or further lines of therapy after failure.
Conclusion Fluoropyrimidine-based combination chemotherapy regimens appear to be equally active and tolerable as first-line therapy for ACC.

참고문헌 (Reference)

1 Ferrara N, "Vascular endothelial growth factor as a target for anticancer therapy" 9 (9): 2-10, 2004

2 Grothey A, "Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment" 22 : 1209-1214, 2004

3 Goldberg RM, "Recent phase III trials of fluorouracil, irinotecan, and oxaliplatin as chemotherapy for metastatic colorectal cancer" 54 (54): S57-S64, 2004

4 Kuebler JP, "Recent experience with oxaliplatin or irinotecan combined with 5-fluorouracil and leucovorin in the treatment of colorectal cancer" 30 (30): 40-46, 2003

5 Cassidy J, "Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer" 26 : 2006-2012, 2008

6 Conroy T, "Quality-of-life findings from a randomised phase-III study of XELOX vs FOLFOX-6 in metastatic colorectal cancer" 102 : 59-67, 2010

7 Glimelius B, "Quality of life during chemotherapy in patients with symptomatic advanced colorectal cancer. The Nordic Gastrointestinal Tumor Adjuvant Therapy Group" 73 : 556-562, 1994

8 Porschen R, "Phase III study of capecitabine plus oxaliplatin compared with fluorouracil and leucovorin plus oxaliplatin in metastatic colorectal cancer: a final report of the AIO Colorectal Study Group" 25 : 4217-4223, 2007

9 Diaz-Rubio E, "Phase III study of capecitabine plus oxaliplatin compared with continuous-infusion fluorouracil plus oxaliplatin as first-line therapy in metastatic colorectal cancer: final report of the Spanish Cooperative Group for the Treatment of Digestive Tumors Trial" 25 : 4224-4230, 2007

10 Borner MM, "Patient preference and pharmacokinetics of oral modulated UFT versus intravenous fluorouracil and leucovorin: a randomised crossover trial in advanced colorectal cancer" 38 : 349-358, 2002

11 Raymond E, "Oxaliplatin: a review of preclinical and clinical studies" 9 : 1053-1071, 1998

12 Van Cutsem E, "Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study" 19 : 4097-4106, 2001

13 Therasse P, "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" 92 : 205-216, 2000

14 원영주, "Nationwide Cancer Incidence in Korea, 2003~2005" 대한암학회 41 (41): 122-131, 2009

15 de Gramont A, "Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer" 18 : 2938-2947, 2000

16 Saltz LB, "Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group" 343 : 905-914, 2000

17 Douillard JY, "Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial" 355 : 1041-1047, 2000

18 Park SH, "First-line chemotherapy with irinotecan plus capecitabine for advanced colorectal cancer" KARGER 66 : 353-357, 2004

19 Tournigand C, "FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study" 22 : 229-237, 2004

20 Arkenau HT, "Efficacy of oxaliplatin plus capecitabine or infusional fluorouracil/leucovorin in patients with metastatic colorectal cancer: a pooled analysis of randomized trials" 26 : 5910-5917, 2008

21 Mullany S, "Effect of adding the topoisomerase I poison 7-ethyl-10-hydroxycamptothecin (SN-38) to 5-fluorouracil and folinic acid in HCT-8 cells: elevated dTTP pools and enhanced cytotoxicity" 42 : 391-399, 1998

22 Hoff PM, "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" 19 : 2282-2292, 2001

23 Twelves C, "Can capecitabine replace 5-FU/leucovorin in combination with oxaliplatin for the treatment of advanced colorectal cancer" 16 (16): 23-26, 2002

24 Goldberg RM, "A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer" 22 : 23-30, 2004

25 Machover D, "A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma" 80 : 1179-1187, 1997