Phase II study of weekly high dose fluorouracil in previously treated patients with metastatic colorectal cancer

TEGAFIRI is an effective alternative regimen for the management of recurrent or metastatic colorectal cancer

At present, the global incidence of colorectal cancer is increasing, with numerous individuals succumbing to the disease. The standard treatment strategy for colorectal cancer is curative resection. However, a cure is rarely achieved for metastatic colorectal cancer. Currently, chemotherapy is the main treatment for metastatic and recurrent colorectal cancer. The majority of metastases or recurrences have been found to respond well to chemotherapy. The present study evaluated the response rates of recurrent or metastatic colorectal cancer patients treated with a combination chemotherapy of irinotecan and oral uracil-tegafur (UFUR). In the pilot study, 33 patients with metastatic or recurrent colorectal cancer were treated with different regimens of irinotecan and UFUR with or without leucovorin; however, irinotecan (150 mg/m2 every two weeks) with continuous UFUR and leucovorin without interruption resulted in improved survival compared with the other regimens evaluated and, thus, was employed for the present study of 113 patients. The patients that received irinotecan with UFUR and leucovorin without interruption exhibited similar efficacy in terms of overall survival and response rate to that of the pilot study. In addition, the incidences of diarrhea, alopecia and hematologic toxicity were acceptable, which was in agreement with the results of the pilot study. Therefore, combination chemotherapy with irinotecan, oral UFUR and leucovorin appears to be a satisfactory treatment strategy for recurrent or metastatic colorectal cancer.

Retrospective comparison of single-agent chemotherapy with weekly 5-fluorouracil or weekly irinotecan in previously treated patients with metastatic colorectal cancer

This study is a retrospective analysis of response, toxicity and freedom from progression of two single-agent chemotherapy regimens in patients with previously treated metastatic colorectal cancer. Thirty-five patients with histologically confirmed measurable metastatic colorectal cancer received chemotherapy after failure of first-line 5-fluorouracil (5-FU) and leucovorin treatment. The median age was 61 years. Twenty-seven patients had liver metastases, 6 had local recurrence, 1 had retroperitoneal lymph node metastases and 1 had lung metastases. Eighteen patients received weekly 2600 mg/m2 5-FU and 17 patients received weekly 125 mg/m2 irinotecan (CPT-11). Treatment was given until disease progression. Total number of cycles was 202 for 5-FU and 248 for CPT-11. The relative dose intensity was 1.0 for 5-FU and 0.84 for CPT-11. No grade 3-4 toxicity was registered in patients who received 5-FU. Grade 3-4 toxicity rates were as follows in those who received CPT-11: vomiting 1 (5.9%) patient in 1 cycle, diarrhea 3 (17.7%) patients in 3 cycles and neutropenia in 3 (17.7%) patients in 3 cycles. No patients manifested febrile neutropenia. Two patients (11.8%) needed hospital admission because of toxicity: 1 for vomiting and 1 for diarrhea. No objective responses were observed in the 5-FU group of patients. Three patients (17.6%) who received CPT-11, achieved partial response with a median duration of 8 months. Stable disease was registered in 3 (17.6%) and 9 (52.9%) patients in 5-FU and CPT-11 groups respectively (p=0.05). Median time to progression was 3.3 months for patients who received 5-FU and 4.2 months for those treated with CPT-11 (not significant). One-year survival was 22.2% and 54.3% respectively (p=0.05).

CONCLUSION

Weekly chemotherapy with CPT-11 is tolerated with acceptable toxicity and leads to a better response rate than weekly high dose 5-FU. It also significantly improves survival but does not prolong freedom from progression.