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First-Line Capecitabine/Irinotecan Promising in Metastatic Colorectal Cancer

First-Line Capecitabine/Irinotecan Promising in Metastatic Colorectal Cancer

OXFORD, UK—The combination of capecitabine (Xeloda) and irinotecan
(Camptosar) appears to be an effective, easy-to-use, and well-tolerated
treatment for patients with metastatic colorectal cancer, according to
results of a phase I/II trial conducted by British and Dutch researchers.

David J. Kerr, Rhodes Professor of Therapeutics and Clinical Pharmacology
and director of the National Translational Cancer Research Network, Oxford
University, presented the results at a poster session of the annual meeting
of the American Society of Clinical Oncology (abstract 643).

The study examined the safety and efficacy of five dosage levels of the
drugs among 36 patients with histologically proven, measurable metastatic
disease of the colon or rectum. The patients ranged in age from 37 to 76
(median, 61), had a WHO performance status of 2 or less, and had organ
involvement at 1 or 2 sites, primarily liver and/or lungs. Nine patients had
received adjuvant chemotherapy (which may have included
fluorouracil/leucovorin), and seven had received radiotherapy. None had
received chemotherapy for their metastatic disease.

Dosage Regimen

The capecitabine/irinotecan regimen was given in a 21-day cycle
consisting of irinotecan by 30-minute IV infusion on day 1 and capecitabine
orally twice a day on days 1 to 14, with a 1-week rest before the next
cycle. Dose levels were as follows (all capecitabine doses are twice daily):
Level 1: irinotecan 200 mg/m², capecitabine 750 mg/m²; level 2: irinotecan
250 mg/m², capecitabine 750 mg/m²; level 3: irinotecan 250 mg/m², capecitabine
1,000 mg/m²; level 4: irinotecan 300 mg/m², capecitabine 1,000 mg/m²; and
level 5: irinotecan 300 mg/m², capecitabine 1,250 mg/m².

"We asked the patients to start taking capecitabine at home,"
Dr. Kerr said, "and then 2, 3, or 4 hours later, they would receive the
infusion of irinotecan."

The researchers defined dose-limiting toxicity as grade 4 neutropenia for
7 days or longer; grade 4 thrombocytopenia; grade 3-4 infection; grade 3-4
stomatitis; grade 3-4 diarrhea or grade 2 diarrhea for more than 8 days;
grade 4 vomiting; grade 3-4 skin erythema; grade 3-4 hand-foot syndrome for
2 or more days; other toxicities (except alopecia), grade 3-4; and all
toxicities preventing oral intake of at least 10 capecitabine doses.

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