scholarly journals Chemotherapy of advanced colorectal cancer: When do we have to stop?

2016 ◽  
Vol 63 (1) ◽  
pp. 29-32
Author(s):  
Davorin Radosavljevic
Keyword(s):  
Colorectal Cancer ◽  
Advanced Colorectal Cancer ◽  
Positive Impact ◽  
Tumour Progression ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Good Communication ◽  
Tumour Characteristics ◽  
Unacceptable Toxicity

Chemotherapy of advanced colorectal cancer improved significantly patients? survival in last two decades. Continuum of treatment means that patient should receive all valuable drugs active in metastatic colorectal patients, during the treatment course, but detailed treatment plan should be made taking into account patient and tumour characteristics, and drug availability. Several treatment strategies should provide patients with optimal balance between efficacy and treatment toxicity. Decision about stopping systemic chemotherapy, after tumour progression or unacceptable toxicity, and transition to palliative treatment is not an easy task for doctor and requires a really good communication with patient. Continuation of systemic treatment in very advanced disease, in pre-terminal patients, may adversely affect patient?s overall quality of life, and very rarely has a positive impact on length of survival.

Health related quality of life in older or frail patients with advanced colorectal cancer treated with dose reduced capecitabine

2018 ◽  
Vol 9 (6) ◽  
pp. 659-664 ◽  
Author(s):  
Daniel Breadner ◽  
Mark David Vincent ◽  
Derek Jonker ◽  
Christine Cripps ◽  
Paul Klimo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Advanced Colorectal Cancer ◽  
Health Related Quality ◽  
Frail Patients ◽  
Related Quality ◽  
Health Related

Fluorouracil and leucovorin with or without interferon alfa-2b in advanced colorectal cancer: analysis of a prospective randomized phase III trial. Hellenic Cooperative Oncology Group.

1996 ◽  
Vol 14 (10) ◽  
pp. 2682-2687 ◽  
Author(s):  
P A Kosmidis ◽  
N Tsavaris ◽  
D Skarlos ◽  
D Theocharis ◽  
E Samantas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Advanced Colorectal Cancer ◽  
Positive Impact ◽  
Performance Status ◽  
Final Analysis ◽  
Interferon Alfa ◽  
Phase Iii ◽  
Psychological Reactions ◽  
Group A ◽  
Group B

PURPOSE To investigate if double modulation of fluorouracil (5-FU) with leucovorin (folinic acid [FA]) and interferon alfa-2b (IFN 2b) improves responses and survival in comparison to single modulation of 5-FU with FA. PATIENTS AND METHODS One hundred six patients with histologically confirmed advanced colorectal cancer, measurable disease, and without previous chemotherapy were prospectively randomized into two groups. Patients in group A received 5-FU 450 mg/m2 as an intravenous bolus in the midinfusion of FA weekly. FA was given at a dose of 200 mg/m2 in 500 mL 0.9% normal saline solution in 2-hour infusion. Patients in group B received exactly the same regimen plus IFN 2b 5 million units subcutaneously three times weekly. RESULTS All patients were well balanced in both groups regarding age, sex, performance status, number, and site of metastasis. One hundred two patients were assessable. All patients have died. There was no difference in response between the two groups (7.8% v 9.8%). Median survival was 10.1 months in group A, and 7.2 months in group B (P = .00189). Median time to progression was 8.4 and 5.2 months, respectively (P = .00196). Overall, better performance status and older age had a positive impact on survival. Toxicity was the most important and catastrophic aspect of this study. Patients who received IFN 2b had significantly worse anemia, neutropenia, diarrhea, anorexia, weight loss, flu-like syndrome, and psychological reactions. CONCLUSION Based on this final analysis, the addition of IFN 2b to the combination of 5-FU and FA enhances toxicity and contributes to decreased survival.

Impact of protracted venous infusion fluorouracil with or without interferon alfa-2b on tumor response, survival, and quality of life in advanced colorectal cancer.

1995 ◽  
Vol 13 (9) ◽  
pp. 2317-2323 ◽  
Author(s):  
M Hill ◽  
A Norman ◽  
D Cunningham ◽  
M Findlay ◽  
M Watson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Advanced Colorectal Cancer ◽  
Symptomatic Improvement ◽  
Interferon Alfa ◽  
Life Questionnaire ◽  
European Organization ◽  
Significant Difference ◽  
Venous Infusion

PURPOSE The aim of this study was to investigate the effects of adding interferon alfa-2b (IFN) to protracted venous infusion fluorouracil (PVI 5-FU) from the start of treatment in patients with advanced colorectal cancer. PATIENTS AND METHODS Patients who attended our unit with histologically confirmed advanced colorectal cancer were randomized to receive either PVI 5-FU 300 mg/m2/d via Hickman line, and IFN 5 MU subcutaneously three times weekly, or PVI 5-FU alone. Treatment was given for a maximum of two 10-week blocks, with a 2-week gap for reassessment of all parameters. Quality of life (QL) was measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) pretreatment and every 6 weeks thereafter. RESULTS A total of 160 patients were randomized, with 155 eligible for assessment. Radiologic response was observed in 43 patients (28%): 17 of 77 (22%) in the 5-FU-plus-IFN arm (all partial responses [PRs]) and 26 of 78 (33%) in the 5-FU-alone group (complete responses [CRs] and 22 PRs) (difference not significant). Symptomatic improvement occurred in the majority of patients, and equally in both arms: 61% to 80% depending on the symptom. There was no significant difference between the two groups in failure-free survival (median, 161 v 193 days) or overall survival (median, 328 v 357 days). However, patients who received IFN did experience significantly more toxicity in the form of leukopenia (P = .001), neutropenia (P = .04), mucositis (P = .008), and alopecia (P = .0002). There were no toxic deaths and few notable differences in QL between the two arms. CONCLUSION This study confirms that PVI 5-FU is effective in treating the symptoms associated with metastatic colorectal carcinoma, with only mild to moderate toxicity and maintenance of QL. IFN 5 MU three times weekly does not enhance these palliative benefits.

A Randomized Trial Comparing Defined-Duration With Continuous Irinotecan Until Disease Progression in Fluoropyrimidine and Thymidylate Synthase Inhibitor—Resistant Advanced Colorectal Cancer

2004 ◽  
Vol 22 (15) ◽  
pp. 3023-3031 ◽  
Author(s):  
Rohit Lal ◽  
James Dickson ◽  
David Cunningham ◽  
Ian Chau ◽  
Andrew R. Norman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Disease Progression ◽  
Advanced Colorectal Cancer ◽  
Phase Iii ◽  
Random Assignment ◽  
Duration Of Disease ◽  
Grade 3 ◽  
Synthase Inhibitor

Purpose Irinotecan given until disease progression is an accepted standard treatment for advanced colorectal cancer (CRC) resistant to fluoropyrimidines. It is not known whether a predefined period of irinotecan treatment would result in similar duration of disease control. We performed a multicenter phase III trial to compare the two policies of defined-duration versus continuous irinotecan treatment. Patients and Methods Three hundred thirty-three eligible patients with advanced CRC progressing on or within 24 weeks of completing fluoropyrimidine-based chemotherapy were prospectively registered. After receiving eight cycles of irinotecan given at 350 mg/m2 once every 3 weeks, 55 patients with responding or stable disease were randomly assigned to stop irinotecan (n = 30) or continue until disease progression (n = 25). Registered patients were not randomly assigned predominantly due to disease progression (n = 236) and intolerable toxicity (n = 38). Results From the time of random assignment, there were no differences in failure-free survival (P = .999) or overall survival (P = .11) between the two arms. No difference was seen in mean global health status quality-of-life score between the two arms at 12 weeks after random assignment. No grade 3 diarrhea and febrile neutropenia was seen in the continue-irinotecan arm after random assignment. Conclusion For most patients, the decision to continue on irinotecan beyond 24 weeks is influenced by disease progression or treatment-related toxicity. However, for 17% of patients in whom this decision is clinically relevant, there seems to be little benefit from continuing irinotecan, though the drug was well tolerated without any deterioration in quality of life.

A retrospective study of first-line combination chemotherapy in advanced colorectal cancer: A Korean single-center experience.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 623-623
Author(s):  
S. Lee ◽  
J. Park ◽  
S. Park ◽  
W. Kang ◽  
H. Lim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Folinic Acid ◽  
Combination Chemotherapy ◽  
Advanced Colorectal Cancer ◽  
First Line ◽  
Single Center Experience ◽  
First Line Therapy ◽  
Significant Difference ◽  
Line Setting ◽  
Unacceptable Toxicity

623 Background: Fluoropyrimidine-based combination chemotherapy, in combination with either oxaliplatin or irinotecan, have demonstrated efficacy and tolerability against advanced colorectal cancer (ACC). Methods: Between Jan 2006 and Dec 2007, 478 ACC patients were treated with combination chemotherapy in first-line setting: 5-fluorouracil, folinic acid plus oxaliplatin (FOLFOX, n=172), 5-fluorouracil, folinic acid plus irinotecan (FOLFIRI, n=95), capecitabine plus oxaliplatin (XELOX, n=155), and capecitabine plus irinotecan (XELIRI, n=56). FOLFOX and FOLFIRI were repeated every 2 weeks, whereas XELOX and XELIRI were repeated every 3 weeks until disease progression or unacceptable toxicity occurred or until a patient chose to discontinue treatment. Results: The median age was 58 years (range, 19-84 years) and the median chemotherapy duration for FOLFOX, FOLFIRI, XELOX and XELIRI were 4.9, 4.5, 5.7 and 5.4 months, respectively. Combination chemotherapy regimens were generally well tolerated. The estimated median PFS for all patients was 6.8 months (95% confidence interval, 6.3-7.3 months). No statistically significant difference in PFS was found each regimen used as first-line chemotherapy. Sixty-percent (n=290) of patients received second or further lines of therapy after failure. Conclusions: Fluoropyrimidine-based combination chemotherapy regimens appear to be equally active and tolerable as first-line therapy for ACC. No significant financial relationships to disclose.

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