A prospective randomlsed trial of protracted venous infusion (PVI) 5-FU with or without mitomycin C (MMC) in advanced colorectal cancer

Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer

PURPOSE

We report the results of a prospectively randomized study that compared the combination of epirubicin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) (ECF) with the combination of mitomycin, cisplatin, and PVI 5-FU (MCF) in previously untreated patients with advanced esophagogastric cancer.

PATIENTS AND METHODS

Five hundred eighty patients with adenocarcinoma, squamous carcinoma, or undifferentiated carcinoma were randomized to receive either ECF (epirubicin 50 mg/m(2) every 3 weeks, cisplatin 60 mg/m(2) every 3 weeks and PVI 5-FU 200 mg/m(2)/d) or MCF (mitomycin 7 mg/m(2) every 6 weeks, cisplatin 60 mg/m(2) every 3 weeks, and PVI 5-FU 300 mg/m(2)/d) and analyzed for survival, response, toxicity, and quality of life (QOL).

RESULTS

The overall response rate was 42.4% (95% confidence interval [CI], 37% to 48%) with ECF and 44.1% (95% CI, 38% to 50%) with MCF (P =.692). Toxicity was tolerable, and there were only two toxic deaths. ECF resulted in more grade 3/4 neutropenia and grade 2 alopecia, but MCF caused more thrombocytopenia and plantar-palmar erythema. Median survival was 9.4 months with ECF and 8.7 months with MCF (P =.315); at 1 year, 40.2% (95% CI, 34% to 46%) of ECF and 32.7% (95% CI, 27% to 38%) of MCF patients were alive. Median failure-free survival was 7 months with both regimens. Global QOL scores were better with ECF at 3 and 6 months.

CONCLUSION

This study confirms response, survival, and QOL benefits of ECF observed in a previous randomized study. The equivalent efficacy of MCF was demonstrated, but QOL was superior with ECF. ECF remains one of the reference treatments for advanced esophagogastric cancer.

Single agent infusional 5-fluorouracil is not effective second-line therapy after raltitrexed (Tomudex) in advanced colorectal cancer

Raltitrexed (Tomudex) is currently licensed for first-line treatment of advanced colorectal cancer. We evaluated 101 patients treated with raltitrexed whose data were collected prospectively, in order to study the outcome of second-line treatments used after this drug. Of 98 evaluable patients, 50 received second-line treatments, the commonest being 5-fluorouracil (5-FU)-based therapy (22 patients with 20 evaluable) and mitomycin-c (MMC) (22 patients with 18 evaluable). Only 1 response was seen in a patient treated with 5-FU and MMC and none following other treatments. This patient was not evaluable for outcome of raltitrexed treatment, having stopped after two courses. Patients who had responded to raltitrexed and later progressed off treatment were more likely to be offered second-line 5-FU, but despite the earlier sensitivity to thymidylate synthase inhibition, response rates were minimal. Underlying mechanisms for this lack of activity and proposals for future studies are discussed.