Oxaliplatin, irinotecan and capecitabine (OCX) for first-line treatment of advanced/metastatic colorectal cancer: a phase I trial (SAKK 41/03)

A Phase I Study of Irinotecan, Capecitabine (Xeloda), and Oxaliplatin in Patients With Advanced Colorectal Cancer

BACKGROUND

The objective of the present phase I study was to define the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of irinotecan, capecitabine, and oxaliplatin given in combination (IXO regimen) to patients with previously untreated, unresectable advanced or metastatic colorectal cancer (CRC).

PATIENTS AND METHODS

Patients received oxaliplatin followed by irinotecan as intravenous infusions on day 1, with oral capecitabine taken twice daily (BID) on days 2 to 15 of a 3-week cycle. The dose ranges were explored as follows: oxaliplatin, 75 to 120 mg/m²; irinotecan, 160 to 230 mg/m²; capecitabine, 750 to 1000 mg/m² BID. Dose escalation was performed individually for each drug at each dose level according to the type and severity of toxicity encountered in the previous cohort.

RESULTS

A total of 39 patients were enrolled at 7 dose levels and the MTD. The recommended doses for phase II evaluation were oxaliplatin 100 mg/m², irinotecan 160 mg/m², and capecitabine 950 mg/m² BID. Diarrhea and febrile neutropenia were DLTs. Of the 39 enrolled patients, 26 (67%) had confirmed objective responses. The median progression-free survival was 11 months, and the median overall survival was 25 months. The survival rate at 5 years was 23%.

CONCLUSION

The IXO regimen has a manageable toxicity profile with promising antitumor activity as first-line treatment of advanced and metastatic CRC.

Efficacy of triplet combination chemotherapy with oxaliplatin, irinotecan and capecitabine (OCX) in metastatic colorectal cancer in relation to RAS/RAF mutation status: results of a retrospective analysis

BACKGROUND

The triplet combination of fluorouracil, oxaliplatin and irinotecan for metastatic colorectal cancer improves efficacy at the cost of increased toxicity. Preliminary reports indicate that triplet combination regimens might improve outcome in the RAS/RAF-mutated subgroup.

PATIENTS AND METHODS

This retrospective analysis included 25 patients with metastatic colorectal cancer, who received treatment with OCX (oxaliplatin, irinotecan, capecitabine). The regimen consisted of oxaliplatin 70 mg/m2 on days 1 and 15, irinotecan 100 mg/m2 on days 8 and 22, and capecitabine 1,400 mg/m2 on days 1-29 every 5 weeks. KRAS, NRAS, and BRAF mutations were determined by Sanger sequencing.

RESULTS

23 patients received at least 1 cycle and were evaluable for efficacy. In 10 patients, a KRAS or BRAF mutation was detected. Partial remission rate was 61%, median progression-free survival 9.8 months, and median overall survival 32.9 months for all evaluable patients. No difference in efficacy was detected between the RAS/RAF wild-type and the mutant group. OCX was well tolerated with no grade 3/4 haematological events. Diarrhoea was the major non-haematological toxicity (24% grade 3).

CONCLUSION

In this retrospective analysis, triplet chemotherapy with OCX was well tolerated and achieved encouraging efficacy in metastatic colorectal cancer irrespective of RAS/RAF mutation status.

Current status of pharmacological treatment of colorectal cancer

AIM: To review the clinical trials for the development in drugs for chemotherapeutic treatment of colorectal cancer (CRC).

METHODS: A systematic review identified randomized controlled trials (RCTs) assessing drugs for the treatment of CRC or adenomatous polyps from www.clinicaltrials.gov. Various online medical databases were searched for relevant publications.

RESULTS: Combination treatment regimens of standard drugs with newer agents have been shown to improve overall survival, disease-free survival, time to progression and quality of life compared to that with standard drugs alone in patients with advanced colorectal cancer. The FOLFOXIRI regimen has been associated with a significantly higher response rate, progression-free survival and overall survival compared to the FOLFIRI regimen.

CONCLUSION: Oxaliplatin plus intravenous bolus fluorouracil and leucovorin has been shown to be superior for disease-free survival when compared to intravenous bolus fluorouracil and leucovorin. In addition, oxaliplatin regimens were more likely to result in successful surgical resections. First line treatment with cetuximab plus fluorouracil, leucovorin and irinotecan has been found to reduce the risk of metastatic progression in patients with epidermal growth factor receptor-positive colorectal cancer with unresectable metastases. The addition of bevacizumab has been shown to significantly increase overall and progression-free survival when given in combination with standard therapy.

ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making

Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.