Subacute renal failure in diabetic nephropathy due to endocapillary glomerulonephritis and cholesterol embolization

Patients with established diabetic nephropathy could have other glomerular diseases superimposed on diabetic glomerulosclerosis. Cholesterol embolization syndrome (CES) is a systemic disorder caused by cholesterol crystal embolization from ulcerated atherosclerosis plaques in the aorta and its major branches. Curiously, there are few papers describing the association between diabetic nephropathy and CES. On the other hand, the clinical picture of CES resembles systemic vasculitis, and there is a controversy regarding the association between CES and glomerular or vascular inflammation. We report a case of atypical CES that developed after cardiac catheterization in a diabetic man; it presented as subacute renal failure with proliferative and exudative endocapillary glomerulonephritis.

Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer

PURPOSE

To evaluate whether capecitabine plus oxaliplatin (XELOX) is noninferior to fluorouracil. folinic acid, and oxaliplatin (FOLFOX-4) as first-line therapy in metastatic colorectal cancer (MCRC).

PATIENTS AND METHODS

The initial design of this trial was a randomized, two-arm, noninferiority, phase III comparison of XELOX versus FOLFOX-4. After patient accrual had begun, the trial design was amended in 2003 after bevacizumab phase III data became available. The resulting 2 x 2 factorial design randomly assigned patients to XELOX versus FOLFOX-4, and then to also receive either bevacizumab or placebo. We report here the results of the analysis of the XELOX versus FOLFOX-4 arms. The analysis of bevacizumab versus placebo with oxaliplatin-based chemotherapy is reported separately. The prespecified primary end point for the noninferiority analysis was progression-free survival.

RESULTS

The intent-to-treat population comprised 634 patients from the original two-arm portion of the study, plus an additional 1,400 patients after the start of the amended 2 x 2 design, for a total of 2,034 patients. The median PFS was 8.0 months in the pooled XELOX-containing arms versus 8.5 months in the FOLFOX-4-containing arms (hazard ratio [HR], 1.04; 97.5% CI, 0.93 to 1.16). The median overall survival was 19.8 months with XELOX versus 19.6 months with FOLFOX-4 (HR, 0.99; 97.5% CI, 0.88 to 1.12). FOLFOX-4 was associated with more grade 3/4 neutropenia/granulocytopenia and febrile neutropenia than XELOX, and XELOX with more grade 3 diarrhea and grade 3 hand-foot syndrome than FOLFOX-4.

CONCLUSION

XELOX is noninferior to FOLFOX-4 as a first-line treatment for MCRC, and may be considered as a routine treatment option for appropriate patients.

Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer

PURPOSE

To evaluate whether capecitabine plus oxaliplatin (XELOX) is noninferior to fluorouracil. folinic acid, and oxaliplatin (FOLFOX-4) as first-line therapy in metastatic colorectal cancer (MCRC).

PATIENTS AND METHODS

The initial design of this trial was a randomized, two-arm, noninferiority, phase III comparison of XELOX versus FOLFOX-4. After patient accrual had begun, the trial design was amended in 2003 after bevacizumab phase III data became available. The resulting 2 x 2 factorial design randomly assigned patients to XELOX versus FOLFOX-4, and then to also receive either bevacizumab or placebo. We report here the results of the analysis of the XELOX versus FOLFOX-4 arms. The analysis of bevacizumab versus placebo with oxaliplatin-based chemotherapy is reported separately. The prespecified primary end point for the noninferiority analysis was progression-free survival.

RESULTS

The intent-to-treat population comprised 634 patients from the original two-arm portion of the study, plus an additional 1,400 patients after the start of the amended 2 x 2 design, for a total of 2,034 patients. The median PFS was 8.0 months in the pooled XELOX-containing arms versus 8.5 months in the FOLFOX-4-containing arms (hazard ratio [HR], 1.04; 97.5% CI, 0.93 to 1.16). The median overall survival was 19.8 months with XELOX versus 19.6 months with FOLFOX-4 (HR, 0.99; 97.5% CI, 0.88 to 1.12). FOLFOX-4 was associated with more grade 3/4 neutropenia/granulocytopenia and febrile neutropenia than XELOX, and XELOX with more grade 3 diarrhea and grade 3 hand-foot syndrome than FOLFOX-4.

CONCLUSION

XELOX is noninferior to FOLFOX-4 as a first-line treatment for MCRC, and may be considered as a routine treatment option for appropriate patients.

Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study

PURPOSE

To evaluate the efficacy and safety of bevacizumab when added to first-line oxaliplatin-based chemotherapy (either capecitabine plus oxaliplatin [XELOX] or fluorouracil/folinic acid plus oxaliplatin [FOLFOX-4]) in patients with metastatic colorectal cancer (MCRC).

PATIENTS AND METHODS

Patients with MCRC were randomly assigned, in a 2 x 2 factorial design, to XELOX versus FOLFOX-4, and then to bevacizumab versus placebo. The primary end point was progression-free survival (PFS).

RESULTS

A total of 1,401 patients were randomly assigned in this 2 x 2 analysis. Median progression-free survival (PFS) was 9.4 months in the bevacizumab group and 8.0 months in the placebo group (hazard ratio [HR], 0.83; 97.5% CI, 0.72 to 0.95; P = .0023). Median overall survival was 21.3 months in the bevacizumab group and 19.9 months in the placebo group (HR, 0.89; 97.5% CI, 0.76 to 1.03; P = .077). Response rates were similar in both arms. Analysis of treatment withdrawals showed that, despite protocol allowance of treatment continuation until disease progression, only 29% and 47% of bevacizumab and placebo recipients, respectively, were treated until progression. The toxicity profile of bevacizumab was consistent with that documented in previous trials.

CONCLUSION

The addition of bevacizumab to oxaliplatin-based chemotherapy significantly improved PFS in this first-line trial in patients with MCRC. Overall survival differences did not reach statistical significance, and response rate was not improved by the addition of bevacizumab. Treatment continuation until disease progression may be necessary in order to optimize the contribution of bevacizumab to therapy.

Low prevalence of Listeria monocytogenes in cull sows and pork

The goal of this study was to determine the prevalence of Listeria monocytogenes in sows slaughtered at a single Midwestern plant on two occasions (trial 1, n = 179 sows; trial 2, n = 160 sows). Fecal samples collected antemortem (trial 1) as well as animal tissues, and carcass swabs collected at the abattoir (trials 1 and 2) were analyzed. Eight isolates of L. monocytogenes were recovered from five samples that represented 0.18% of the total samples (n = 2,775). In trial 1, L. monocytogenes was detected in a tonsil sample (0.6%; 1 positive of 181 tonsils), in a carcass (0.6%; 1 positive of 179 carcasses), which was sampled prior to the organic rinse, and in two chopped meat block samples (1.2%; 2 positive of 165 samples). In trial 2, L. monocytogenes was only detected in a single chopped meat block sample (0.15%; 1 positive of 688 total samples). These data indicate the low prevalence of L. monocytogenes in the cull sow.

[Comorbidity, anemia and response to erythropoiesis stimulating agents in chronic hemodialysis]

INTRODUCTION

Patients treated with haemodialysis have a high prevalence of co-morbidity that induces a elevate mortality risk. On the other hand, these patients have anaemia whose treatment is based in erythropoiesis stimulating agents. To date there are not enough studies to determine if co-morbidity alters erythropoietin response and the relationship between co-morbidity, response to treatment of anaemia and resistance to erythropoiesis-stimulating agents.

OBJECTIVES

We have the following objectives: i) to study the prevalence of associated diseases in patients treated with haemodialysis in our Hospital Unit and to evaluate the co-morbidity Charlson Index, ii) to know the degree of anaemia control, dose and response to erythropoiesis-stimulating agents, and iii) to determine the relationship with co-morbidity and anaemia treatment.

PATIENTS AND METHODS

We designed a retrospective study in stable haemodialysis treated patients. We calculated the Charlson co-morbidity index adjusted to age and we analysed levels of haemoglobin in the 6 months before study, dose of erythropoiesis-stimulating agents and its resistance index defined as doses of erythropoiesis-stimulating agents/weight (kg)/week/haemoglobin (g/dL). The different variables included in Charlson index were considered as independent variables and the index to repose to erythropoiesis-stimulating agents as a dependent variable, using bivariant and multivariate statistical analysis.

RESULTS

We included 58 patients (31 males and 27 females), median age of 69.5 years (range 24-88), mean haemodialysis 83.7 months. Mean Charlson index was 7.4 +/- 2.8 (range 2-13). Comorbidity-age Charlson index was 2 in 3.4% of patients; 10.3% had 3 or 4 points; 43.2% between 5 and 7 and 43,1% 8 or more. Mean haemoglobin levels was 11,7+/-1,2 g/dL. Mean erythropoiesis-stimulating agents dose was 163.7+/-114.5 IU/kg/week and resistance index 14.1+/-9.7. Most of patients (57%) had a IRE value higher than 10. Fourteen patients (24%) had haemoglobin less than 11 g/dL, and 3 of them (5.1%) received erythropoiesis-stimulating agents more than 300 IU/kg/week. Nine subjects (15.5%) was treated with high dose of erythropoiesis-stimulating agents (>300 IU/kg/week): 3 of them had Hb>or=11 g/dL and 6 had Hb<11 g/dL. We did not found that the intensity of Charlson index is related with the degree of anaemia control or response to erythropoiesis-stimulating agents.

CONCLUSIONS

Although the co-morbidity index is high and the response to erythropoiesis-stimulating agents is inadequate. In our study there is not relationship between these conditions.

Enfriamiento artificial y tasa de concepción de vaquillas holstein con estrés térmico

Las altas temperaturas afectan la reproducción del ganado bovino reduciendo la intensidad del estro y la fertilidad. Basado en lo anterior el objetivo del estudio fue evaluar los efectos de la inseminación artificial (IA) a tiempo fijo más un período corto de enfriamiento ambiental sobre la tasa de concepción y respuesta fisiológica de vaquillas bajo estrés calórico. Noventa vaquillas Holstein fueron distribuidas aleatoriamente en uno de los siguientes tratamientos: Un tratamiento testigo (T1) con detección visual de estro e IA mañana-tarde (n= 30); un segundo tratamiento (T2) bajo un protocolo de IA a tiempo fijo (n= 30) y un tercer tratamiento (T3) con el mismo protocolo de IA de T2 más un período de enfriamiento ambiental (ventilación y aspersión) de las vaquillas 11 d antes y 21 d después de la IA (n= 30). El experimento se dividió en dos períodos: el primero del 25 de junio al 26 de julio; el segundo del 15 de agosto al 16 de septiembre. En el primer periodo las vaquillas en T3 tuvieron una temperatura rectal (39,35oC) más baja (p

Randomized phase II study of cisplatin and 5-FU continuous infusion (PF) versus cisplatin, UFT and vinorelbine (UFTVP) as induction chemotherapy in locally advanced squamous cell head and neck cancer (LA-SCHNC)

OBJECTIVES

We conducted a multicentric randomized phase II trial comparing 5-FU continuous infusion (PF) and cisplatin, UFT and vinorelbine (UFTVP) as induction chemotherapy (IC) in locally advanced squamous cell head and neck cancer (LA-SCHNC). Primary objective was complete response (CR) to IC and overall survival (OS) was a secondary objective.

MATERIALS AND METHODS

PF: cisplatin 100 mg/m(2) i.v. Day 1 (D1) and 5-FU 1,000 mg/m(2) per day i.v. continous infusion D1-D5, every 21 days. UFTVP: cisplatin 100 mg/m(2) i.v. D1; UFT 200 mg/m(2) per day p.o. D1-D21 and vinorelbine 25 mg/m(2) i.v. D1 and D8, every 21 days. Four IC courses were planned in both arms.

RESULTS

A total of 206 patients (pts) were included (PF/UFTVP: 99/107): oral cavity: 8%/10%, oropharynx: 20%/25%, hypopharynx: 17%/14%, larynx: 54%/50%. Stage (TNM, 2002): III: 41%/35%, IVA: 23%/27%, IVB: 35%/38%. Complete response to IC: PF:36%/UFTVP:31% (P: no significative (NS)). G 3-4 toxicity (PF/UFTVP): neutropenia: 52%/72%; febrile neutropenia: 3%/20% (P < 0.001); anaemia:1%/14% (P < 0.001); trombocytopenia: 5%/0% (P = 0.02); mucositis: 15%/7% (P < 0.001). Deaths during IC: 2(2%)/3(3%). IC with UFTVP was associated with a favourable OS in the Cox analysis (actuarial 5 year OS: 49% vs. 34%; HR: 0.67, 95% CI: 0.47-0.95, P: 0.03).

CONCLUSIONS

Although clinical response is equal in both arms, overall survival (Cox) is better in the UFTVP arm. Febrile neutropenia and anaemia were more frequent with UFTVP while mucositis and trombocytopenia were more severe with PF.

Reintroduction of oxaliplatin is associated with improved survival in advanced colorectal cancer

PURPOSE

In the OPTIMOX1 trial, previously untreated patients with advanced colorectal cancer were randomly assigned to two different schedules of leucovorin, fluorouracil, and oxaliplatin that were administered until progression in the control arm or in a stop-and-go fashion in the experimental arm. The randomly assigned treatment groups did not differ significantly in terms of response rate, progression-free survival, and overall survival (OS). However, the impact of oxaliplatin reintroduction on OS was potentially masked by the fact that a large number of patients did not receive the planned oxaliplatin reintroduction or received oxaliplatin after second-line therapy in both treatment groups.

PATIENTS AND METHODS

A Cox model was fitted with all significant baseline factors plus time-dependent variables reflecting tumor progression, reintroduction of oxaliplatin, and use of second-line irinotecan. A shared frailty model was fitted with all significant baseline factors plus the number of lines of chemotherapy received by the patient and the percentage of patients with oxaliplatin reintroduction in the center. An adjusted hazard ratio (HR) was calculated for three reintroduction classes (1% to 20%, 21% to 40%, and > 40%), using centers with no reintroduction (0%) as the reference group.

RESULTS

Oxaliplatin reintroduction had an independent and significant impact on OS (HR = 0.56, P = .009). The percentage of patients with oxaliplatin reintroductions also had a significant impact on OS. Centers in which more than 40% of the patients were reintroduced had an adjusted HR for OS of 0.59 compared with centers in which no patient was reintroduced.

CONCLUSION

Oxaliplatin reintroduction is associated with improved survival in patients with advanced colorectal cancer.

Long term results of a phase II trial of induction chemotherapy with uracil-ftegafur (UFT), vinorelbine and cisplatin (UFTVP) followed by radiotherapy concomitant with UFT and carboplatin (RT/UFTJ) in non-resectable locally advanced (stage IV-B) squamous cell head and neck carcinoma and peripheral blood stem cell support (PBSCS) with febrile neutropenia

PURPOSE

To evaluate the response of advanced squamous cell head and neck carcinoma to a combination of induction chemotherapy and radiotherapy.

METHODS

We present long-term results of a phase II trial of Induction Chemotherapy with UFT 200 mg/m(2) p.o. days 1 to 21, Vinorelbine 25 mg/m(2) i.v. days 1 and 8 and Cisplatin 100 mg/m(2) i.v. day 1 (UFTVP) each 21 days for 4 courses, followed by Radiotherapy concomitant with UFT 100 mg/m(2) p.o. daily and Carboplatin AUC = 0.5 i.v. weekly (RT/UFTJ) in patients (pts) with Non-Resectable Locally Advanced (Stage IV-B) Squamous Cell Head and Neck Carcinoma (IV-B-SCHNC). Primary endpoint was Complete Response to induction UFTVP and secondary endpoints were Disease Free Status Rate after locoregional treatment and long-term Overall Survival. Between 1994 and 1997, 32 pts were included.

RESULTS

Complete Response to Induction UFTVP was 59% (95% CI: 48%-70%). Main toxicity of UFTVP was G 3,4 neutropenia (94% of pts; 25% developed febrile neutropenia and 1 of this pts dead). After Induction Chemotherapy with UFTVP, 30 pts received radiotherapy and 25 of them received concomitant Carboplatin and UFT (RT/UFTJ): main toxicity was mucositis (G3-4: 72%) and one patient died during RT/UFTJ because pneumonia. Twenty-five pts (78%) were alive and disease free at the end of the whole treatment. Actuarial 5 year Overall survival is 32%.

CONCLUSION

Although toxicity is important, this approach has interesting activity and deserves further investigation.

Phase II of trastuzumab and cisplatin in patients (pts) with advanced gastric cancer (AGC) with HER2/neu overexpression/amplification

4613

Background: Trastuzumab(T) exhibits activity in human gastric cancer cells that overexpress HER2/neu. We previously reported a 13.5% HER2/neu overexpression/amplification in AGC or gastroesofageal junction (GEJ) cancers (Grávalos C, et al. J Clin Oncol 24, 18S, 200s, abstr # 4089). We designed a phase II trial to determine the efficacy and tolerability of T and cisplatin(C) in pts with ACG with HER2/neu overexpression/amplification. Exploratory objectives include analysis of c-erbB-2 extracellular domain and correlation of the results with histological erB-2/neu overexpression and with clinical response Methods: Chemo-naïve pts with adenocarcinoma histopatologically confirmed, HER2/neu overexpression/amplification, measurable, no operable, locally advanced or metastatic AGC, age ≥ 18, ECOG ≤ 2, FEVI ≥ 50% and adequate organ function were eligible. Prior adjuvant radiotherapy or/and chemotherapy were allowed. Immunohistochemistry (IHC) was performed using herceptest. A fluorescence in situ hybridization (FISH) assay was done when IHQ was = 2. HER2/neu expression was considered negative if IHC= 0, 1 or IHC=2 and FISH -; and positive if IHC=2 and FISH + or IHC=3. T 8 mg/kg d1 (loading dose in first cycle) and 6 mg/kg (maintenance doses) and C 75 mg/m2 d1 were administered every 21 days until progression, unacceptable toxicity or withdrawal inform consent Results: 21 pts has been included. 17 are evaluable. 16 were men. Median age 66 (50–78). ECOG 0/1: 5/12. Histological subtypes were: 50% intestinal, 25% diffuse and 25% unknown. 56% had gastric localization and 44% GEJ. 16 pts had metastases (59% liver, 47% lymph nodes, 23% peritoneum, 17% lung, and 24% others). Prior treatment: 5 pts underwent surgery and 2 had adjuvant chemotherapy. Median cycles 2 (1–14). Efficacy: 6 (35%) pts achieved response (1/5 CR/PR), 3 (17%) stabilization (52% control disease = RC + PR+SD), 4 pts with progression disease, 4 pts too early Tolerance: There was no grade 4 toxicity. Main grade 3 adverse events included: asthenia (3 pts), nauseas/vomiting (3), diarrhea (2), hiporexia (2) and neutropenia (1) Conclusions: Trastuzumab and cisplatin is a well tolerated regimen with a promising activity. The study is ongoing and an update will be presented at the meeting.

No significant financial relationships to disclose.

Retrospective analysis of surgical resection after induction chemotherapy for patients with T4b squamous cell head and neck cancer

16517

Background: Although standard treatment of patients with T4b Squamous Cell Head and Neck Cancer (T4b-SCHNC) for the last decade has been concomitant Chemo-Radiotherapy (CT-RT), recent Phase III trials with new Induction Chemotherapy (IC) regimens suggest that IC could also play a role in this setting. The value of adding surgery of the residual mass after IC and before RT if the resection is technically feasible is not clear in this context. Methods: We present the results of a retrospective analysis focused on this topic. Results: Between 1984 and 2001, 113 patients (pts) with T4b-SCHNC were treated at our institution with platin-based IC. Four pts dead during IC and 57 pts achieved a complete or a >90% partial response at primary and proceeded to definitive RT (or concomitant CT/RT). In the other 52 pts, surgical resection was reconsidered after IC and before RT and in 13 of them this surgery was performed: in 7 pts (6 had PR and 1 minor response after IC) the resection was R1, all these patients had loco-regional progression (2 of them also developed systemic metastases) and median OS after surgery was 21 months with no patient alive at 48 months; In the other 6 pts (3 had a PR and 3 had minor response after IC) an R0 resection was performed: 3 of these pts had loco-regional relapses (1 of them also developed systemic metastases) and the other 3 pts remain alive and disease free 56, 62 and 72 months after surgery. OS of the 52 pts that achieved less than a 90% partial response at primary with IC, was equivalent for those no resected after IC pts and for R1 resected pts (actuarial 5 year OS 8% vs 0%, lrk, p=0,74) but a statistically significant improvement in OS was observed when an R0 resection was obtained after IC (actuarial 5 years OS 50%, lrk, p=0,02).Conclusions: R0 resections after IC and before RT could improve OS in pts with T4b-SCHNC that obtain less than a 90%PR at primary after IC. R1 resection appears to have no value in this setting. This approach should be studied in properly designed prospective clinical trials.

No significant financial relationships to disclose.

Preliminary efficacy of bevacizumab with first-line FOLFOX, XELOX, FOLFIRI and monotherapy for mCRC: First BEATrial

4072

Background: In a phase III pivotal trial in patients (pts) with metastatic colorectal cancer (mCRC), BEV (BEV, Avastin®) increased overall survival (OS) by 30% when added to first-line IFL chemotherapy (CT). Recently, a second trial reported a significant improvement in progression free survival (PFS) when BEV was added to FOLFOX/XELOX in a similar patient population. Although, First BEAT was opened to evaluate the safety profile of BEV in a broader pt population using a variety of CT regimens, efficacy endpoints were investigated. Methods: First BEAT enrolled 1,927 mCRC patients in 41 countries between June 2004 and February 2006. Eligible pts were treated with first-line CT (physician’s choice) in combination with BEV (5mg/kg q2w [5-FU-based CT] or 7.5mg/kg q3w [capecitabine [cap, Xeloda®]-based CT]) until disease progression. Secondary endpoints included OS, time to progression (TTP) and PFS. Disease progression was assessed by investigators. Results: By Nov 15th, 2006, 1,914/1,927 pts had data available for analysis (male 58%; median age 59 years, 33% =65 years; ECOG PS 0/1 65%/34%). Median follow-up was 15 months; 60-day mortality was 2.5%. Patients receiving 5-FU/cap CT appeared to have poorer prognosis with respect to age =65 years (41%), ECOG PS 0/1 (58%/42%) and 60-day mortality rate (6.6%), compared with those receiving doublet CT regimens. The most common first-line CT regimens used with BEV were FOLFOX (28%), FOLFIRI (26%), XELOX (18%) and 5-FU or cap CT (16%). Median PFS was 10.4 (95% CI: 10.1–10.9 months, based on 882 events), 10.5 (9.7 - 11.6) in FOLFOX, 10.3 (9.7 - 10.7) in XELOX, 11.1 (10.2–12.0) in FOLFIRI and 9.1 (8.1–10.3) in pts receiving 5-FU or cap CT, respectively. TTP was 10.8 (95% CI: 10.4–11.3 months, based on 805 events). Updated analyses will be presented. Conclusions: In this ongoing, large community-based study, the preliminary efficacy of first line BEV in mCRC pts receiving a variety of CT regimens appears consistent with that observed in large phase III randomised trials.

[Table: see text]

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

PURPOSE

The aim of this phase III trial was to compare the efficacy and safety of capecitabine plus oxaliplatin (XELOX) versus Spanish-based continuous-infusion high-dose fluorouracil (FU) plus oxaliplatin (FUOX) regimens as first-line therapy for metastatic colorectal cancer (MCRC).

PATIENTS AND METHODS

A total of 348 patients were randomly assigned to receive XELOX (oral capecitabine 1,000 mg/m2 bid for 14 days plus oxaliplatin 130 mg/m2 on day 1 every 3 weeks) or FUOX (continuous-infusion FU 2,250 mg/m2 during 48 hours on days 1, 8, 15, 22, 29, and 36 plus oxaliplatin 85 mg/m2 on days 1, 15, and 29 every 6 weeks).

RESULTS

There were no significant differences in efficacy between XELOX and FUOX arms, which showed, respectively, median time to tumor progression (TTP; 8.9 v 9.5 months; P = .153); median overall survival (18.1 v 20.8 months; P = .145); and confirmed response rate (RR; 37% v 46%; P = .539). The safety profile of the two regimens was similar, although there were lower rates of grade 3/4 diarrhea (14% v 24%) and grade 1/2 stomatitis (28% v 43%), and higher rates of grade 1/2 hyperbilirubinemia (37% v 21%) and grade 1/2 hand-foot syndrome (14% v 5%) with XELOX versus FUOX, respectively.

CONCLUSION

This randomized study shows a similar TTP of XELOX compared with FUOX in the first-line treatment of MCRC, although there was a trend for slightly lower RR and survival. XELOX can be considered as an alternative to FUOX.

Chemotherapy of advanced gastric cancer

Gastric cancer is the second most frequent cancer in the world. Approximately 84% of patients with gastric cancer will have advanced disease and median survival of these patients without chemotherapy is only 3-4 months. "Classical" chemotherapy regimens, mainly CF (cisplatin plus infusional 5FU) and ECF (cisplatin plus infusional 5FU plus Epirubicin) obtain responses in 20-40% of the patients and improve quality of life. Nevertheless, duration of these responses is short with very few complete responses. Median time to tumor progression (TTP) with these regimens is only about 4-5 months and median survival does not exceed 7-10 months. Moreover, benefit seems to be limited to patients with good performance status and treatment toxicity and discomfort are not negligible, specially that of regimens with cisplatin or infusional 5FU. Trying to improve these results, the incorporation of new drugs has been explored. Among the new combinations, the more developed ones are those with Docetaxel (DCF), oxaliplatin (EOX, FLO), Capecitabine (EOX, cisplatin-Xeloda) and irinotecan (ILF). We have final results from Phase III trials that suggest that all these regimens could have a role in the treatment of these patients but survival is still very poor and toxicity remains important. It would be interesting to investigate other new combinations and the incorporation of drugs directed against new therapeutic targets in this setting. It would be of utmost interest that these clinical trials would also explore clinical and molecular prognostic and predictive factors.