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Posted by on Mar 13, 2013 in Colorectal cancer | 0 comments

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In a nutshell

The present clinical trial compared two chemotherapy regimens as first-line treatment for patients with metastatic colorectal cancer (mCRC): XELIRI-bevacizumav versus FOLFIRI-bevacizumab.

Some background

Approximately one quarter of patients with colorectal cancer (cancer in the large intestine) have metastases, or stage IV cancer (cancer that has spread to distant organs), at the time of their diagnosis. Prognosis of these patients is usually poorer than in patients with cancer that is confined to the bowel. However, new chemotherapy drugs have been proven to reduce symptoms and prolong survival for these patients. Chemotherapy drugs enter the bloodstream (systemic chemotherapy) and attack cancer cells, thus slowing cancer progression and alleviating cancer-related symptoms.

Several drugs can be used in the treatment of mCRC and often 2 or more are combined (chemotherapy regimens) to increase effectiveness and reduce side-effects. FOLFIRI is a regimen that combines 5-fluorouracil (5FU), leucovorin (folinic acid) and irinotecan, whereas XELIRI is the combination of capecitabine (Xeloda) and irinotecan. More recently, the addition of targeted therapies like bevacizumab (Avastin) – a drug that stops the cancer from growing by blocking its blood supply – has been found to provide additional benefit. This study compared the efficacy of these two regimens (FOLFIRI and XELIRI) plus avastin as the first treatment given to patients with mCRC.

Methods & findings

285 patients with mCRC were included in the study. Patients were randomly treated either with XELIRI-avastin (143 patients), either with FOLFIRI-avastin (142 patients). Parameters measured were overall survival, or OS (defined as the percentage of patients who have survived for a certain period of time), progression-free survival, or PFS (defined as the percentage of patients who have survived for a defined period of time, without progression of their cancer) and regimen-related side effects.

After approximately 42 months of follow-up, median OS was 20 months in the XELIRI-avastin group, with an OS rate of 44%, compared to 25.3 months in the FOLFIRI-avastin group with a 54% OS rate. The PFS rate was 18% for patients treated with XELIRI-bev and 17% for patients who received FOLFIRI-bev. The most common side effects from either regimen were low white blood cell count and diarrhea; vomiting occured more frequently following XELIRI.

The bottom line

In conclusion, there were no significant differences in efficacy for the two chemotherapy regimens. The side effect profile differed between drugs.

Published By :

BMC cancer

Date :

Jun 29, 2012

Original Title :

XELIRI-bevacizumab versus FOLFIRI-bevacizumab as first-line treatment in patients with metastatic colorectal cancer: a Hellenic Cooperative Oncology Group phase III trial with collateral biomarker analysis

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