According to a recent report in The New England Journal of Medicine, initial treatment with FOLFOXIRI plus Avastin® (bevacizumab), rather than FOLFIRI plus Avastin, improved progression-free survival in adults with inoperable metastatic colorectal cancer.
According to estimates from the American Cancer Society, more than 102,000 new cases of colon cancer and about 40,000 new cases of rectal cancer were diagnosed in the United States in 2013. Together, the diseases were responsible for over 50,000 deaths. There is, however, good news about colorectal cancer in the United States: death rates associated with the disease have dropped during the past 15 years, and advances continue to be made in screening, prevention, and treatment. Unfortunately many individuals will fail initial therapy and develop metastatic disease. Continued development of drugs to treat metastatic colon cancer is necessary to further improve outcomes.
A standard initial therapy for advanced colorectal cancer is FOLFIRI (fluorouracil plus leucovorin and irinotecan) plus bevacizumab (256 patients). The investigators hoped to improve the outcomes obtained with FOLFIRI by adding an additional chemotherapy agent, oxaliplatin to the regimen. This experimental regimen, FOLFOXIRI (fluorouracil plus leucovorin and irinotecan and oxaliplatin) plus bevacizumab was directly compared to FOLFIRI in the clinical study.
Overall 508 patients with unresectable metastatic colorectal cancer who had not received previous chemotherapy or biologic therapy for their metastatic disease were treated at 34 medical centers across Italy. Both groups received maintenance therapy with fluorouracil plus Avastin® until the cancer progressed or they withdrew from the study.
Study participants had been followed for an average of 32 months at the time of publication. Individuals treated with FOLFOXIRI were more likely to develop some side effects including neutropenia, diarrhea, stomatitis, and peripheral neuropathy. FOLFOXIRI treated patients survived longer and experienced a delay in cancer progression compared to those treated with FOLFIRI. Median overall survival was 5 months longer with FOLFOXIRI and survival without cancer progression was 12.1 months with FOLFOXIRI compared to 9.7 months with FOLFIRI.
Reference:(N. Engl. J. Med. 2014 Oct. 23 [doi:10.1056/NEJMoa1403108]).
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