In a nutshell
The aim of this study was to investigate FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, and fluorouracil) before pre-surgery chemoradiotherapy (CRT) for patients with rectal cancer (RC). The study found that FOLFIRINOX given before CRT and surgery improved the outcomes of these patients.
Some background
RC can be treated with surgery to remove the tumor. In general, patients are given a combination of chemotherapy (CT) and radiation therapy (RT) before surgery to shrink tumors and kill any cancer cells that may have spread around. After surgery, patients may receive further CT to kill any cancer cells that may have been left behind. This reduces the risk of recurrence. However, even with this aggressive regimen, recurrences, and metastasis (cancer spreading) still happen.
Adding more chemotherapy before standard therapy might reduce the risk of cancer recurring or spreading.
Methods & findings
This study included data from 461 patients with RC that were scheduled for CRT and surgery. 231 patients were given FOLFIRINOX chemotherapy followed by CRT and surgery (group 1). 230 patients were given the standard therapy, CRT followed by surgery (group 2). All patients had further chemotherapy following surgery. The average follow-up time was 46.5 months.
After 3 years, 91% of patients in group 1 and 88% in group 2 were alive. 76% in group 1 and 69% in group 2 were alive and disease-free after 3 years. The addition of FOLFIRINOX before CRT was associated with a 31% higher chance of disease-free survival.
Serious side effects occurred in 27% of group 1 and 22% of group 2. This was not considered significant. The most common side effects were low blood cell counts, diarrhea, and tiredness.
The bottom line
The study concluded that FOLFIRINOX before pre-surgery CRT improved the outcomes of patients with RC.
The fine print
The impact of FOLFIRINOX on patient quality of life was not reported here.
Published By :
The Lancet. Oncology
Date :
Apr 13, 2021
