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Zhang S, Yang J, Zhan H, Yang B, Rong P, Luo Y, Shi C, Chen Y, Yang J. Incidence and non-genetic risk factors of irinotecan-induced severe neutropenia in Chinese adult inpatients. Medicine (Baltimore) 2023; 102:e33005. [PMID: 36862924 PMCID: PMC9981354 DOI: 10.1097/md.0000000000033005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
To analyze the incidence and nongenetic risk factors of irinotecan-induced severe neutropenia in the hospital, and provide additional reference and help for clinical treatment. A retrospective analysis of patients who received irinotecan based chemotherapy from May 2014 to May 2019 in Renmin Hospital of Wuhan University was conducted. Univariate analysis and binary logistic regression analysis with the forward stepwise method were used to assess the risk factors associated with severe neutropenia induced by irinotecan. Of the 1312 patients treated with irinotecan-based regmines, only 612 patients met the inclusion criteria, and 32 patients developed irinotecan-induced severe neutropenia. In the univariate analysis, variables associated with severe neutropenia were tumor type, tumor stage, and therapeutic regimen. In the multivariate analysis, irinotecan plus lobaplatin, lung cancer or ovarian cancer, tumor stage T2, T3, and T4, were identified as risk factors that contributed independently to irinotecan-induced severe neutropenia (P < .05), respectively. The results showed that the incidence of irinotecan-induced severe neutropenia was 5.23% in the hospital. The risk factors included tumor type (lung cancer or ovarian cancer), tumor stage (T2, T3, and T4) and therapeutic regimen (irinotecan plus lobaplatin). Therefore, for patients with these risk factors, it might be advisable to actively consider optimum management to reduce the occurrence of irinotecan-induced severe neutropenia.
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Affiliation(s)
- Shuxiao Zhang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - JingXiang Yang
- Department of Pharmacy, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Haiyan Zhan
- Department of Pharmacy, Wuhan Jinyintan Hospital, Wuhan, China
| | - Boning Yang
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - PeiPei Rong
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi Luo
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Cai Shi
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Chen
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Yang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
- * Correspondence: Jian Yang, Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan 430060, China (e-mail: )
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Moriya H, Saito K, Helsby N, Sugino S, Yamakage M, Sawaguchi T, Takasaki M, Kato H, Kurosawa N. Association between the low-dose irinotecan regimen-induced occurrence of grade 4 neutropenia and genetic variants of UGT1A1 in patients with gynecological cancers. Oncol Lett 2014; 7:2035-2040. [PMID: 24932285 PMCID: PMC4049750 DOI: 10.3892/ol.2014.2046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/20/2014] [Indexed: 12/14/2022] Open
Abstract
The occurrence of severe neutropenia during treatment with irinotecan (CPT-11) is associated with the *6 and *28 alleles of uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1). However, the correlation between these variants and the occurrence of severe neutropenia in a low-dose CPT-11 regimen for the treatment of gynecological cancers has not been extensively studied. There are also no studies regarding the association between the 421C>A mutation in ATP-binding cassette sub-family G member 2 (ABCG2) and the occurrence of severe neutropenia in CPT-11-treated patients with gynecological cancers. The present study was designed to determine the factors associated with the occurrence of grade 4 neutropenia during chemotherapy for gynecological cancers with combinations of CPT-11 and cisplatin or mitomycin C. In total, 44 patients with gynecological cancer were enrolled in the study. The association between the absolute neutrophil count (ANC) nadir values, the total dose of CPT-11 and the genotypes of UGT1A1 or ABCG2 was studied. No correlation was observed between the ANC nadir values and the total dose of CPT-11. The ANC nadir values in the UGT1A1*6/*28 and *6/*6 groups were significantly lower compared with those in the *1/*1 group (P<0.01). Univariate analysis showed no association between the occurrence of grade 4 neutropenia and the ABCG2 421C>A mutation. Subsequent to narrowing the factors by univariate analysis, multivariate logistic regression analysis only detected significant correlations between the occurrence of grade 4 neutropenia and the UGT1A1*6/*6 and *6/*28 groups (P=0.029; odds ratio, 6.90; 95% confidence interval, 1.22-38.99). No associations were detected between the occurrence of grade 4 neutropenia and the heterozygous variant (*1/*6 or *1/*28) genotype, type of regimen or age. In conclusion, the UGT1A1*6/*28 and *6/*6 genotypes were found to be associated with the occurrence of severe neutropenia in the low-dose CPT-11 regimen for gynecological cancers. This finding indicates that the determination of UGT1A1 variants may be as useful in CPT-11 chemotherapy for gynecological conditions as it is in colorectal and lung cancer patients treated with this drug.
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Affiliation(s)
- Hiroyuki Moriya
- Department of Pharmacy, Hokkaido Pharmaceutical University School of Pharmacy, Otaru, Japan
| | - Katsuhiko Saito
- Department of Pharmacy, Hokkaido Pharmaceutical University School of Pharmacy, Otaru, Japan
| | - Nuala Helsby
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shigekazu Sugino
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeru Sawaguchi
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Masahiko Takasaki
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Hidenori Kato
- Department of Gynecology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Nahoko Kurosawa
- Department of Pharmacy, Hokkaido Pharmaceutical University School of Pharmacy, Otaru, Japan
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Treatment Strategy for Elderly Patients with Metastatic Colorectal Cancer: A Review of the Systemic Chemotherapy Options. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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4
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Comella P, Massidda B, Natale D, Putzu C, Sandomenico C, Filippelli G, Palmeri S, Condemi G, Vessia G, Barberis G, Ionta MT, Tafuto S, Barbato E. Efficacy and Tolerability of Biweekly Bevacizumab, Irinotecan, Folinic Acid and Fluorouracil Intravenous Bolus (BIFF Regimen) in Patients With Metastatic Colorectal Cancer: The Southern Italy Cooperative Oncology Group Experience. Clin Colorectal Cancer 2011; 10:42-7. [DOI: 10.3816/ccc.2011.n.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kovoor PA, Karim SM, Marshall JL. Is Levoleucovorin an Alternative to Racemic Leucovorin? A Literature Review. Clin Colorectal Cancer 2009; 8:200-6. [DOI: 10.3816/ccc.2009.n.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Feliu J, Sereno M, Castro JD, Belda C, Casado E, González-Barón M. Chemotherapy for colorectal cancer in the elderly: Whom to treat and what to use. Cancer Treat Rev 2009; 35:246-54. [PMID: 19345021 DOI: 10.1016/j.ctrv.2008.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 11/13/2008] [Accepted: 11/17/2008] [Indexed: 12/27/2022]
Abstract
The median age at diagnosis of colorectal cancer is during the seventh decade, and the incidence of the disease increases continuously with age. However, as the age increases, the possibilities of receiving adequate cancer treatment diminish and the mortality rises. So, there is a huge need for defined treatment strategies in elderly patients with colorectal carcinoma. The geriatric population is a very heterogeneous group where patients with an excellent health status coexist with the patients with both co-morbidities and functional dependency. Therefore, it is necessary to personalize each treatment according to the degree of vulnerability of the elderly patients. It is essential to set up a multidimensional geriatric assessment in order to consider not only the stage of the disease, but also all the factors that may influence the survival and interfere with the treatment. The aim of this review is to discuss the potential benefits and issues of chemotherapy in the elderly patients affected with colorectal cancer.
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Affiliation(s)
- Jaime Feliu
- Medical Oncology Department, La Paz Hospital, Madrid, Spain
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7
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Kweekel D, Guchelaar HJ, Gelderblom H. Clinical and pharmacogenetic factors associated with irinotecan toxicity. Cancer Treat Rev 2008; 34:656-69. [DOI: 10.1016/j.ctrv.2008.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 04/29/2008] [Accepted: 05/02/2008] [Indexed: 01/26/2023]
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Irinotecan in the treatment of elderly patients with advanced colorectal cancer. Crit Rev Oncol Hematol 2008; 68:250-5. [PMID: 18722784 DOI: 10.1016/j.critrevonc.2008.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 05/26/2008] [Accepted: 05/30/2008] [Indexed: 01/03/2023] Open
Abstract
UNLABELLED Irinotecan is an active drug in the first and subsequent lines of chemotherapy for patients with advanced colorectal cancer. Frequently, the elderly patients are excluded from receiving irinotecan alone or in combination, and on many occasions these patients receive an initial reduced dose of this drug. This revision has been focused in the role of irinotecan in elderly patients. MATERIAL AND METHODS Data from pharmacokinetic studies, comparative analysis of prospective trials according to age and prospective studies with irinotecan alone or irinotecan-combinations in the elderly have been revised and put into context. RESULTS Either pharmacokinetic and clinical data suggest that fit elderly patients may tolerate irinotecan as well as the younger population. Response rate and survival achieved in elderly patients with irinotecan combinations seem to be equivalent to that obtained in younger patients. CONCLUSION Elderly patients with advanced colorectal cancer should be carefully evaluated in order to be classified as fit or not fit through a comprehensive geriatric assessment. For the group of fit elderly patients, irinotecan may be used as in the younger population.
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François E, Berdah JF, Chamorey E, Lesbats G, Teissier E, Codoul JF, Badetti JL, Hébert C, Mari V. Use of the folinic acid/5-fluorouracil/irinotecan (FOLFIRI 1) regimen in elderly patients as a first-line treatment for metastatic colorectal cancer: a Phase II study. Cancer Chemother Pharmacol 2008; 62:931-6. [DOI: 10.1007/s00280-008-0681-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 01/07/2008] [Indexed: 10/22/2022]
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10
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Bernardi D, Errante D, Tirelli U, Salvagno L, Bianco A, Fentiman IS. Insight into the treatment of cancer in older patients: Developments in the last decade. Cancer Treat Rev 2006; 32:277-88. [PMID: 16698183 DOI: 10.1016/j.ctrv.2006.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 03/17/2006] [Accepted: 03/20/2006] [Indexed: 11/15/2022]
Abstract
In the last decades there has been an increased interest in the treatment of elderly cancer patients and a change in attitude of both clinicians and their patients has occurred. Drugs are now available that might be considered "elderly-friendly" and the enormous advances in surgical procedures and supportive treatments over the recent years have enabled adverse effects to be minimized. A Geriatric Assessment is increasingly used as a tool to define those patients who are more suitable for aggressive chemotherapy or, on the contrary, palliative treatment. For almost all cancers, older patients are better treated today than they were in the past, even though we are still far from optimal management. Despite the perceived barriers to including elderly patients in clinical trials, there are few data to support excluding them. We must not permit increased age in cancer patients to continue to be an important and independent risk factor for receiving inadequate care.
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Affiliation(s)
- Daniele Bernardi
- Division of Medical Oncology, Ospedale Civile, Via Forlanini 71, 31029 Vittorio Veneto (TV), Italy.
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11
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Comella P, Massidda B, Filippelli G, Natale D, Farris A, Buzzi F, Tafuto S, Maiorino L, Palmeri S, De Lucia L, Mancarella S, Leo S, Roselli M, Lorusso V, De Cataldis G. Safety and Efficacy of Irinotecan plus High-Dose Leucovorin and Intravenous Bolus 5-Fluorouracil for Metastatic Colorectal Cancer: Pooled Analysis of Two Consecutive Southern Italy Cooperative Oncology Group Trials. Clin Colorectal Cancer 2005; 5:203-10. [PMID: 16197624 DOI: 10.3816/ccc.2005.n.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin (LV) 250 mg/m2 plus 5-fluorouracil (5-FU) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer (CRC). PATIENTS AND METHODS Individual data of 254 patients were merged, and baseline features potentially affecting overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and occurrence of severe toxicity were analyzed by univariate and multivariate analyses. RESULTS In the pooled series, ORR was 33% (95% confidence interval [CI], 27%-39%). Liver-only disease (47% vs. 25%; P=0.0012) and absence of previous weight loss (38% vs. 20%; P=0.0189) were significantly associated with a higher ORR on the multivariate analysis. Absence of weight loss (hazard ratio, 1.40; 95% CI, 1.02-1.93; P=0.0377) was significantly associated with a longer PFS (7.5 months vs. 6 months). Median OS was 15.1 months (95% CI, 13.5-16.6 months). Primary surgery, good performance status (PS), only one metastatic site, and oxaliplatin-based second-line treatment independently predicted a longer OS. Grade 4 neutropenia was significantly associated with a PS>or=1, whereas risk of grade>or=3 diarrhea was directly related to age and previous weight loss. CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen, with acceptable toxicity. Notably, the regimen was effective and well tolerated by elderly patients. This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC.
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Affiliation(s)
- Pasquale Comella
- Division of Medical Oncology A, National Tumor Institute, Naples, and Division of Medical Oncology, University Medical School, Cagliari, Italy.
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12
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Comella P, Gambardella A, Farris A, Maiorino L, Natale D, Massidda B, Casaretti R, Tafuto S, Lorusso V, Leo S. A tailored regimen including capecitabine and oxaliplatin for treating elderly patients with metastatic colorectal carcinoma Southern Italy Cooperative Oncology Group trial 0108. Crit Rev Oncol Hematol 2005; 53:133-9. [PMID: 15661564 DOI: 10.1016/j.critrevonc.2004.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2004] [Indexed: 12/27/2022] Open
Abstract
From September 2001 to November 2002, 35 patients aged 70-81 (median, 75) years, with measurable metastatic lesions from colorectal carcinoma, were treated with a combination of oxaliplatin (OXA) infused i.v. over 2 h on day 1, and capecitabine, assumed orally twice a day (12-h apart) from day 2 to day 15. An alternated dose escalation for both drugs was planned over the first three cycles for each patient, in the absence of WHO grade > or =2 toxicity on previous cycle: starting doses were 85 mg/m2 for OXA, and 2000 mg/m2 (day) for capecitabine on first cycle; on second cycle, OXA was planned at 100mg/m2, while capecitabine was planned at 2500 mg/(m2 day) on third cycle. Treatment was repeated every 3 weeks until progression, or for a maximum of 12 cycles. A total of 212 cycles were administered, with a median of 6 (range, 1-12) cycles/patient. Dose escalation was performed in 18 (51%) patients for OXA, and in 4 (11%) patients for capecitabine. No grade 4, and 10 (29%) cases of grade 3 toxicity of any type were reported. Abdominal symptoms (pain, nausea, or vomiting) affected 66% of patients, but they were of grade 3 in only 2 (6%) patients. Grade 3 diarrhoea occurred in 3 (9%) patients. Two complete and 12 partial responses (PR) were reported, for an overall response rate of 40% (95% CI, 24-58%). Progression of disease occurred in 23 (66%) patients, and 18 (51%) died. The actuarial median progression-free and survival time were 6.9 and 14.1 months, respectively.
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Affiliation(s)
- Pasquale Comella
- Division of Medical Oncology A, Department of Medical Oncology, National Tumour Institute, Via M. Semmola, 80131 Naples, Italy.
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Messerer CL, Ramsay EC, Waterhouse D, Ng R, Simms EM, Harasym N, Tardi P, Mayer LD, Bally MB. Liposomal irinotecan: formulation development and therapeutic assessment in murine xenograft models of colorectal cancer. Clin Cancer Res 2005; 10:6638-49. [PMID: 15475454 DOI: 10.1158/1078-0432.ccr-04-0221] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose is to demonstrate whether an appropriately designed liposomal formulation of irinotecan is effective in treating mice with liver-localized colorectal carcinomas. EXPERIMENTAL DESIGN Irinotecan was encapsulated in 1,2-distearoyl-sn-glycero-3-phosphocholine/cholesterol (55:45 molar ratio) liposomes using an ionophore (A23187)-generated transmembrane proton gradient. This formulation was evaluated in vivo by measuring plasma elimination of liposomal lipid and drug after i.v. administration. Therapeutic activity was determined in SCID/Rag-2M mice bearing s.c. LS180 tumors or orthotopic LS174T colorectal metastases. RESULTS Drug elimination from the plasma was significantly reduced when irinotecan was administered in the liposomal formulation. At 1 hour after i.v. administration, circulating levels of the liposomal drug were 100-fold greater than that of irinotecan given at the same dose. High-performance liquid chromatographic analysis of plasma samples indicated that liposomal irinotecan was protected from inactivating hydrolysis to the carboxylate form. This formulation exhibited substantially improved therapeutic effects. For the LS180 solid tumor model, it was shown that after a single injection of liposomal irinotecan at 50 mg/kg, the time to progress to a 400-mg tumor was 34 days (as compared with 22 days for animals treated with free drug at an equivalent dose). In the model of colorectal liver metastases (LS174T), a median survival time of 79 days was observed after treatment with liposomal irinotecan (50 mg/kg, given every 4 days for a total of three doses). Saline and free drug treated mice survived for 34 and 53 days, respectively. CONCLUSIONS These results illustrate that liposomal encapsulation can substantially enhance the therapeutic activity of irinotecan and emphasize the potential for using liposomal irinotecan to treat liver metastases.
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Affiliation(s)
- Corrie Lynn Messerer
- British Columbia Cancer Agency, Department of Advanced Therapeutics, Vancouver, Canada
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14
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O'Neil BH, Goldberg RM. Chemotherapy for advanced colorectal cancer: Let’s not forget how we got here (until we really can). Semin Oncol 2005; 32:35-42. [PMID: 15726504 DOI: 10.1053/j.seminoncol.2004.09.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Physicians and patients alike have been heartened by the recent advances in the treatment of colorectal cancer. The emergence of novel agents that are active in the treatment of this devastating disease, such as cetuximab and bevacizumab, has been particularly notable. However, even before these recent events, a substantial change in prognosis for patients with metastatic colorectal cancer had occurred as a result of advances in traditional chemotherapeutic agents. Refinements in dose, schedule, and sequence continue to be made that could lead to further improvements in outcomes. Additionally, new chemotherapeutic agents with promise for activity in colorectal cancer are being studied. Chemotherapy is likely to remain a central element of the treatment strategy. Our understanding of its current role is discussed in this article.
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Affiliation(s)
- Bert H O'Neil
- UNC Lineberger Comprehensive Cancer Center, 3009 Old Clinic Building, CB #7305, Chapel Hill, NC 27599-7305, USA.
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15
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Chau I, Norman AR, Cunningham D, Waters JS, Topham C, Middleton G, Hill M, Ross PJ, Katopodis R, Stewart G, Oates JR. Elderly patients with fluoropyrimidine and thymidylate synthase inhibitor-resistant advanced colorectal cancer derive similar benefit without excessive toxicity when treated with irinotecan monotherapy. Br J Cancer 2004; 91:1453-8. [PMID: 15365570 PMCID: PMC2409923 DOI: 10.1038/sj.bjc.6602169] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Elderly patients are recommended to have a reduced starting dose (300 mg m−2 once every 3 weeks) of irinotecan monotherapy. The aims of this analysis are to compare toxicity and survival according to age, performance status (PS), gender and prior radical pelvic radiotherapy (RT). The primary end points were overall survival and an irinotecan-specific toxicity composite end point (TCE) defined as the occurrence of grade 3 or 4 diarrhoea, neutropenia, febrile neutropenia, fever, infection or nausea and vomiting. Between 1997 and 2003, 339 eligible patients with advanced colorectal cancer (CRC) progressing on or within 24 weeks of completing fluoropyrimidine-based chemotherapy were prospectively registered in a multicentre randomised trial. All patients commenced irinotecan at 350 mg m−2 once every 3 weeks. There were no differences in proportions of patients developing TCE by age (<70 vs ⩾70 : 37.8 vs 45.8%; P=0.218), PS (0–1 vs 2 : 39.3 vs 41.5%; P=0.793) or prior RT (RT vs no RT : 45.1 vs 38.5%; P=0.377). Males experienced more toxicity than females (44.3 vs 32.6%; P=0.031), but this was not significant after controlling for other co-variates (P=0.06). Patients aged ⩾70 had similar objective responses (11.1 vs 9%; P=0.585) and survival (median 9.4 vs 9 months; log rank P=0.74) compared to younger patients. Elderly patients derive the same benefit without experiencing more toxicity with second-line irinotecan treatment for advanced CRC. Our data do not support the recommendation to reduce the starting dose for the elderly patients.
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Affiliation(s)
- I Chau
- Royal Marsden Hospital, London and Surrey, UK
| | - A R Norman
- Royal Marsden Hospital, London and Surrey, UK
| | - D Cunningham
- Royal Marsden Hospital, London and Surrey, UK
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. E-mail:
| | - J S Waters
- Royal Marsden Hospital, London and Surrey, UK
| | - C Topham
- St Luke's Oncology Centre, Guildford, UK
| | | | - M Hill
- Kent Oncology Centre, Maidstone, UK
| | - P J Ross
- Royal Marsden Hospital, London and Surrey, UK
| | - R Katopodis
- Royal Marsden Hospital, London and Surrey, UK
| | - G Stewart
- Royal Marsden Hospital, London and Surrey, UK
| | - J R Oates
- Royal Marsden Hospital, London and Surrey, UK
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16
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Rougier P, Mitry E, Aranda E, Daniele B, Labianca R, Carrato A. Elderly colorectal cancer patients are under treated. EJC Suppl 2004. [DOI: 10.1016/j.ejcsup.2004.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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