Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer

ABSTRACT

The combination of fluorouracil and leucovorin has until recently been standard therapy for metastatic colorectal cancer. Irinotecan prolonge survival in patients refractory to treatment with fluorouracil and leucovorin. We tried to compare a combination of irinotecan, fluorouracil and leucovorin with bolus doses of fluorouracil and leucovorin as first-line therapy for metastatic colorectal cancer. Between January 2000 to December 2001, 30 patients with metastatic colorectal cancer were enrolled, 15 received irinotecan [125mg/m[2]/week x 4 weeks q 6 weeks], 5-FU [500 mg/m[2]/week x 4 weeks q6 weeks iv bolus], and LV [20 mg/m[2]/week x4 weeks q 6 week iv bolus] and 15 patients received 5-FU [425mg/m[2]/d x 5 days q 4 weeks iv bolus] and LV [20mg/m[2]/d x 5 days q 4 weeks iv bolus]. End points included progression -free survival and overall survival. The progression-free survival was longer for the triple-drug therapy than for the two-drug therapy [7 months versus 4 months]. The median survival was also longer in the triple-drug therapy [14 months versus 12 months]. Grade 3/4 neutropenia and mucositis were more common with the two-drug therapy, whereas grade3/4 diarrhea and vomiting were more with the triple-drug therapy. Combining irinotecan with 5-FU/LV was associated with higher rates of tumor regression, progression-free survival and overall survival, and this regimen should be tested as adjuvant treatment in stage III colon cancer