Chemotherapy of metastatic colorectal cancer: fluorouracil plus folinic acid and irinotecan or oxaliplatin.

Abstract

(1) Following the recent introduction of several new cytotoxic agents, a new look at the role of chemotherapy in metastatic colorectal cancer is needed. (2) In one clinical trial of first-line treatment, fluorouracil + folinic acid infusion, after an initial bolus (LV-5FU2 protocol), was more effective and better tolerated than bolus administration alone (Mayo Clinic protocol). (3) Five comparative trials failed to show that raltitrexed was more effective than fluorouracil + folinic acid in first-line treatment, and it has more serious adverse effects. (4) There are no comparative trials of capecitabine or tegafur + uracil versus fluorouracil + folinic acid (LV-5FU2 protocol) in first-line treatment. (5) In three comparative randomised trials involving previously untreated patients, adjunction of oxaliplatin to the fluorouracil + folinic acid combination (FOLFOX protocol) increased both tumour response rate and progression-free survival (by about 2 months), but it also caused more neuropathies, severe diarrhea and severe neutropenia. (6) In two comparative trials of first-line treatment, adjunction of irinotecan to fluorouracil + folinic acid (FOLFIRI protocol) increased the median survival time by about 3 months, to 15-17 months, but increased the incidence of diarrhea, neutropenia, serious cardiovascular disorders and severe thrombosis. (7) In second-line treatment, irinotecan is the only properly assessed drug with a positive impact, prolonging survival compared with appropriate palliative care (34 months after diagnosis, versus 27 months). (8) In one comparative trial, first-line treatment with the FOLFOX protocol, followed by the FOLFIRI protocol, resulted in the same median survival time (21 months) as the reverse sequence. (9) In practice, the first-line treatment for metastatic colorectal cancer appears to be the fluorouracil + folinic acid combination (LV-5FU2 protocol) plus either oxaliplatin (FOLFOX protocol) or irinotecan (FOLFIRI protocol). The reference second-line treatment is the FOLFIRI protocol (or the FOLFOX protocol if the FOLFIRI protocol has already been used). These treatments were associated with the longest survival in one trial.

• Journal: Prescrire international (Prescrire Int) Vol. 14 Issue 80 Pg. 230-3 (Dec 2005) ISSN: 1167-7422 [Print] France
• PMID: 16400749 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antineoplastic Agents
• Organoplatinum Compounds
• Quinazolines
• Thiophenes
• Deoxycytidine
• Tegafur
• Uracil
• Leucovorin
• Fluorouracil
• Camptothecin

Topics

• Antibodies, Monoclonal (administration & dosage, adverse effects, therapeutic use)
• Antineoplastic Agents (administration & dosage, adverse effects, therapeutic use)
• Camptothecin (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Chemotherapy, Adjuvant
• Clinical Trials as Topic
• Colorectal Neoplasms (drug therapy)
• Deoxycytidine (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Drug Therapy, Combination
• Fluorouracil (administration & dosage, adverse effects, therapeutic use)
• Humans
• Leucovorin (administration & dosage, adverse effects, therapeutic use)
• Neoplasm Metastasis
• Organoplatinum Compounds (administration & dosage, adverse effects, therapeutic use)
• Quinazolines (administration & dosage, adverse effects, therapeutic use)
• Tegafur (administration & dosage, adverse effects, therapeutic use)
• Thiophenes (administration & dosage, adverse effects, therapeutic use)
• Treatment Outcome
• Uracil (administration & dosage, adverse effects, therapeutic use)