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Wei Xu, Meng Kuang, Yang Gong, Chunxiang Cao, Jinfei Chen, Cuiju Tang
BACKGROUND: The survival of patients with metastatic colorectal cancer (mCRC) could be improved with exposure to three active drugs, irinotecan, fluorouracil/leucovorin, and oxaliplatin, irrespective of their sequence. However, only 50%-80% of patients can be exposed to all the three drugs in a sequential strategy with two-drug combinations. We carried out this systematic assessment to compare the survival benefit and safety of FOLFOXIRI (irinotecan, fluorouracil/leucovorin, and oxaliplatin) ± bevacizumab (with or without bevacizumab) versus FOLFIRI (irinotecan and fluorouracil/leucovorin) ± bevacizumab (with or without bevacizumab) as first-line treatment for unresectable mCRC...
2016: OncoTargets and Therapy
Jacopo Giuliani, Andrea Bonetti
In light of the relevant expenses of pharmacologic interventions, it might be interesting to make a balance between the cost of the new drugs administered and the difference in progression-free survival in first-line treatments for advanced colorectal cancer. We calculated the pharmacologic costs necessary to get the benefit in progression-free survival for each trial. The costs are from the pharmacy of our hospital in Legnago, Italy. We evaluated 28 phase III randomized controlled trials that included 19,958 patients...
July 19, 2016: Clinical Colorectal Cancer
S Matsusaka, S Cao, D L Hanna, Y Sunakawa, M Ueno, N Mizunuma, W Zhang, D Yang, Y Ning, S Stintzing, A Sebio, S Stremitzer, S Yamauchi, A Parekh, S Okazaki, M D Berger, R El-Khoueiry, A Mendez, W Ichikawa, F Loupakis, H-J Lenz
We analyzed associations between CXCR4/CXCL12 single-nucleotide polymorphisms and outcomes in metastatic colorectal cancer (mCRC) patients who underwent first-line bevacizumab-based chemotherapy. A total of 874 patients were included in this study: 144 treated with bevacizumab and FOLFOX or XELOX (training cohort), 653 treated with bevacizumab and FOLFIRI or FOLFOXIRI (validation cohort A or B) and 77 treated with cetuximab- and oxaliplatin-based regimens (control cohort). One CXCR4 polymorphism (rs2228014) and two CXCL12 polymorphisms (rs1801157 and rs3740085) were analyzed by PCR-based direct sequencing...
August 9, 2016: Pharmacogenomics Journal
Mashaal Dhir, Deepa Magge, Stephanie Novak, David L Bartlett, Amer H Zureikat
BACKGROUND: Hepatic artery infusion (HAI) chemotherapy is an effective regional therapy for unresectable colorectal liver metastases (U-CRLM).1 (,) 2 One of its limitations is the need for a laparotomy, which can delay the use of systemic therapy.3 Here, we describe a purely robotic technique for placement of an HAI pump (Fig 1). PATIENT: A 62-year-old male presented with a symptomatic ascending colon cancer and multiple bilobar unresectable liver metastases. He underwent laparoscopic right colectomy followed by six cycles of FOLFOXIRI and bevacizumab with stable disease by RECIST (Response Evaluation Criteria in Solid Tumors) criteria, and also underwent robotic HAI pump placement...
August 5, 2016: Annals of Surgical Oncology
Caterina Vivaldi, Chiara Caparello, Gianna Musettini, Giulia Pasquini, Silvia Catanese, Lorenzo Fornaro, Monica Lencioni, Alfredo Falcone, Enrico Vasile
FOLFIRINOX is a standard first-line treatment for advanced pancreatic cancer (aPC). The Gruppo Oncologico Nord Ovest (GONO) FOLFOXIRI regimen demonstrated efficacy in metastatic colorectal cancer. We aimed to evaluate activity and tolerability of FOLFOXIRI regimen in patients with aPC and to explore putative prognostic factors. One hundred thirty-seven consecutive aPC patients were treated with FOLFOXIRI in our institution between 2008 and 2014. Clinical, laboratory and pathological data were collected and their association with activity, progression free survival (PFS) and overall survival (OS) was investigated...
August 15, 2016: International Journal of Cancer. Journal International du Cancer
Y Sunakawa, T Bekaii-Saab, S Stintzing
Colorectal cancer is one of the most frequent solid tumors in the western world, with low survival rates in patients with metastatic disease. Doublet chemotherapy regimens such as FOLFOX or FOLFIRI are the mainstay of standard first-line chemotherapy in the metastatic setting. The conventional treatment as a first-line approach is continuous application until progression or intolerable toxicities. However, only one third of patients are treated until progression mainly due to the side effects of chemotherapy...
April 2016: Cancer Treatment Reviews
Johanna C Bendell, Ahmed Zakari, James D Peyton, Ralph Boccia, Mark Moskowitz, Victor Gian, Andrew Lipman, David Waterhouse, Richard LoCicero, Chris Earwood, Cassie M Lane, Anthony Meluch
BACKGROUND: Patients with liver-only metastatic colorectal cancer (mCRC) who are not candidates for potentially curative resection may become resectable with more aggressive chemotherapy regimens. In this nonrandomized trial, we evaluated folinic acid, 5-fluorouracil (5-FU), oxaliplatin, and irinotecan (FOLFOXIRI) plus the epidermal growth factor receptor inhibitor panitumumab as first-line treatment for KRAS wild-type mCRC with liver-only metastasis. METHODS: Patients received FOLFOXIRI (5-FU, 3,200 mg/m(2), 48-hour continuous intravenous (i...
March 2016: Oncologist
C Cremolini, F Loupakis, G Masi, S Lonardi, C Granetto, M L Mancini, S Chiara, R Moretto, D Rossini, S Vitello, G Allegrini, G Tonini, F Bergamo, G Tomasello, M Ronzoni, A Buonadonna, S Bustreo, C Barbara, L Boni, A Falcone
BACKGROUND: FOLFOXIRI plus bevacizumab is a valid option as upfront treatment for metastatic colorectal cancer (mCRC) patients. While several trials investigated the effect of combining bevacizumab with different chemotherapy regimens, including fluoropyrimidines monotherapy and oxaliplatin- or irinotecan-containing doublets, no randomized comparison assessing the impact of the addition of bevacizumab to FOLFOXIRI is available. PATIENTS AND METHODS: A total of 122 mCRC patients received first-line FOLFOXIRI in the phase III trial by the GONO (FOLFOXIRI group) and 252 patients received first-line FOLFOXIRI plus bevacizumab in the TRIBE trial (FOLFOXIRI plus bevacizumab group)...
May 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Yu Sunakawa, Marta Schirripa, Heinz-Josef Lenz
The management of metastatic colorectal cancer substantially improved over the last 10 years and median overall survival of patients might exceed 30 months. The selection of an effective first-line treatment represents a crucial point in order to achieve good outcome results. In the last years, the intensive FOLFOXIRI regimen in combination with bevacizumab became a new standard option in this setting. In the present review we summarized the main steps of FOLFOXIRI regimen development from the first pilot study to the recent findings with biological agents, with a specific focus on practical aspects, such as patient's selection, adverse event management, treatment schedules and post-progression strategies...
April 2016: Critical Reviews in Oncology/hematology
Marwan Al-Hajeili, John L Marshall, Brandon G Smaglo
The curative surgical resection of metastatic disease in patients with stage IV colorectal cancer with a limited tumor burden is standard of care. However, the role for neoadjuvant medical therapy and the ideal composition of that therapy are not established. Several neoadjuvant medical therapies, including standard advanced colorectal cancer chemotherapy regimens-such as folinic acid, fluorouracil (5-FU), and oxaliplatin (FOLFOX); folinic acid, 5-FU, and irinotecan (FOLFIRI); and folinic acid, 5-FU, oxaliplatin, and irinotecan (FOLFOXIRI)-have been evaluated, as has the addition of the biologic agents bevacizumab, panitumumab, and cetuximab...
January 2016: Oncology (Williston Park, NY)
Fotios Loupakis, Alexander Stein, Marc Ychou, Frank Hermann, Antonieta Salud, Pia Österlund
Colorectal cancer is the third most common cancer worldwide. A significant proportion of patients presents with unresectable metastatic disease or develops metachronous metastases following surgical resection of the primary tumor. The prognosis of the disease has improved over the past two decades, with extended multimodality treatment options and the development of increasingly intensified chemotherapy regimens that now typically include targeted biologics. A recent advance in therapy is a treatment regimen composed of three chemotherapeutic agents (i...
June 2016: Targeted Oncology
S Montrone, A Gonnelli, M Cantarella, A Sainato
AIM: Generally speaking, the negative side of radiation treatment of the pelvic district is the toxicity that may compromise the patient's quality of life and lead to temporary suspension of treatment with possible negative effects on its effectiveness. In neoadjuvant radiochemotherapy for locally advanced rectal cancer (LARC), the toxicity that is most frequently observed is proctitis, usually treated with topical corticosteroids or mesalazine. Hyaluronic acid's function is to restore the regular trophism and elasticity of the connective tissues leading to faster repair of the damage, and this could represent a viable option for the control of actinic proctitis...
December 2015: Minerva Gastroenterologica e Dietologica
Masakazu Goto, Hiroshi Okitsu, Yasuhiro Yuasa, Yuta Matsuo, Hiroshi Edagawa, Ryotaro Tani, Osamu Mori, Shunsuke Kuramoto, Atsushi Tomibayashi, Michiko Yamashita, Yoshiyuki Fujii
A 61-year-old man with advanced sigmoid colon cancer was admitted to our hospital. Abdominal computed tomography (CT) revealed locally advanced sigmoid colon cancer, with suspected invasion of the bladder and small intestine. The clinical stage of the disease was T4b, N1, M0, and Stage III a, with wild-type KRAS expression. A transverse colostomy was performed because of the presence of a bowel obstruction. The patient received 4 courses of Leucovorin, 5-fluorouracil, oxaliplatin, and irinotecan (FOLFOXIRI)...
November 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
R Glynne-Jones, N Hava, V Goh, S Bosompem, J Bridgewater, I Chau, A Gaya, H Wasan, B Moran, L Melcher, A MacDonald, M Osborne, S Beare, M Jitlal, A Lopes, M Hall, N West, P Quirke, Wai-Lup Wong, M Harrison
BACKGROUND: In locally advanced rectal cancer (LARC) preoperative chemoradiation (CRT) is the standard of care, but the risk of local recurrence is low with good quality total mesorectal excision (TME), although many still develop metastatic disease. Current challenges in treating rectal cancer include the development of effective organ-preserving approaches and the prevention of subsequent metastatic disease. Neoadjuvant systemic chemotherapy (NACT) alone may reduce local and systemic recurrences, and may be more effective than postoperative treatments which often have poor compliance...
2015: BMC Cancer
Takanori Goi, Takayuki Naruse, Youhei Kimura, Daisuke Fujimoto, Mitsuhiro Morikawa, Kenji Koneri, Akio Yamaguchi
BACKGROUND: Systemic FOLFOX (folinic acid (leucovorin (LV)), 5-fluorouracil (5-FU), and oxaliplatin), FOLFIRI (LV, 5-FU, and irinotecan), or FOLFOXIRI (5-FU, leucovorin, oxaliplatin, and irinotecan) chemotherapy regimens and additional molecular-target treatments, including anti-vascular endothelial growth factor, anti-epidermal growth factor receptor, and anti-multi-kinase antibodies, have been recommended for unresectable recurrent colorectal cancers. However, no effective treatments are currently available for cases refractory to these therapies...
2015: World Journal of Surgical Oncology
Alexander Stein, Djordje Atanackovic, Bert Hildebrandt, Patrick Stübs, Wolfram Brugger, Gunnar Hapke, Claus-Christoph Steffens, Gerald Illerhaus, Ernst Bluemner, Jan Stöhlmacher, Carsten Bokemeyer
BACKGROUND: The addition of bevacizumab (BEV) to standard doublet chemotherapy improves outcomes compared with chemotherapy alone in patients with metastatic colorectal cancer (mCRC). The OPAL study examined the effect of BEV+FOLFOXIRI followed by 5FU/LV and BEV maintenance on progression-free survival (PFS) in patients with previously untreated unresectable mCRC. METHODS: Eligible patients had histologically confirmed mCRC, ECOG performance status ⩽1 and were 18-70 years old...
September 15, 2015: British Journal of Cancer
Sukhontip Klahan, Chi-Cheng Huang, Shu-Chen Chien, Mei-Shin Wu, Henry Sung-Ching Wong, Chien-Yu Huang, Wei-Chiao Chang, Po-Li Wei
Colorectal cancer is one of the most common cancers worldwide. Surgery is usually the primary treatment for colon cancers that have not spread to distant sites. However, chemotherapy may be considered after surgery to eliminate remaining cancer cells or in case the cancer has a high risk of recurrence. Oxaliplatin is often used in combination regimens such as FOLFOX, CapeOX, and FOLFOXIRI because of the cost-effectiveness of adjuvant treatment for patients and also the good tolerability profile. However, some patients show resistance to oxaliplatin which causes poor treatment outcomes...
January 2016: Tumour Biology: the Journal of the International Society for Oncodevelopmental Biology and Medicine
Shouki Bazarbashi, Ali Aljubran, Ahmad Alzahrani, Ahmed Mohieldin, Hussein Soudy, Mohammed Shoukri
Phase III studies have demonstrated the efficacy of FOLFOXIRI regimens (5-fluorouracil/leucovorin, oxaliplatin, irinotecan) with/without bevacizumab in metastatic colorectal cancer (mCRC). Capecitabine is an orally administered fluoropyrimidine that may be used instead of 5-fluorouracil/leucovorin. We evaluated a triple-chemotherapy regimen of capecitabine, oxaliplatin, and irinotecan, plus bevacizumab in 53 patients with mCRC. A Phase I study identified the maximum tolerated dose of irinotecan as 150 mg/m²...
October 2015: Cancer Medicine
Robert C G Martin, Charles R Scoggins, Marshall Schreeder, William S Rilling, Christopher J Laing, Clifton M Tatum, Lawrence R Kelly, Ricardo D Garcia-Monaco, Vivek R Sharma, Todd S Crocenzi, Steven M Strasberg
BACKGROUND: Reports have demonstrated the superior activity of combining both irinotecan and oxaliplatin (FOLFOXIRI) therapy. An option for gaining similar benefits with less toxicity would be the administration of irinotecan through a hepatic artery approach. The aim of this study was to assess the response and adverse event rates for irinotecan drug-eluting beads (DEBIRI) with folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX) and bevacizumab as a first-line treatment for unresectable colorectal liver metastasis...
October 15, 2015: Cancer
Simona R Volovat, Constantin Volovat, Serban M Negru, Mihai Danciu, Viorel Scripcariu
Hepatic arterial infusion (HAI) was evaluated for different drugs to treat hepatic metastasis from colorectal cancer (CRC). Combination treatment with 5-fluorouracil (5-FU), leucovorin, oxaliplatin and irinotecan (FOLFOXIRI) is effective for CRC. A phase II study was conducted to evaluate concomitant HAI administration of oxaliplatin and intravenous leucovorin, 5-FU and irinotecan (FOLFIRI) for patients with inoperable liver metastasis, which had chemotherapy with oxaliplatin (OX) 85 mg/m(2) HAI plus systemic intravenous chemotherapy [leucovorin 200 mg/m(2), 5-FU 2400 mg/m(2) and irinotecan (IRI) 160 mg/m(2) in 48 hours]...
June 2016: Journal of Chemotherapy
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