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First-Line FOLFOX4 Ups Survival in Advanced Colon Cancer

First-Line FOLFOX4 Ups Survival in Advanced Colon Cancer

ORLANDO—Compared with the standard first-line chemotherapy treatment for
advanced colorectal cancer, patients treated with the FOLFOX4 regimen
containing the investigational agent oxaliplatin lived longer and had fewer
side effects.

The FOLFOX4 regimen, also known as the de Gramont regimen, combines
oxaliplatin with an infusion of fluorouracil (5-FU)/leucovorin given over 2
days, while the standard therapy, the Saltz regimen (or IFL) consists of
irinotecan (Camptosar) plus a brief injection of 5-FU/leucovorin. The study
also contained a third arm consisting of oxaliplatin and irinotecan (IROX),
also known as the Wasserman regimen.

Richard M. Goldberg, MD, professor of oncology, Mayo Clinic, presented the
findings from the NCI-sponsored N9741 trial for the North Central Cancer
Treatment Group at an oral session of the 38th Annual Meeting of the American
Society of Clinical Oncology (abstract 511).

Doses for the three study regimens were as follows: IFL: irinotecan 125
mg/m² plus LV 20 mg/m² and 5-FU 500 mg/m²/d on days 1, 8, 15, and 22 every 6
weeks. FOLFOX4: oxaliplatin 85 mg/m² on day 1 plus LV 200 mg/m² and 5-FU 400
mg/m² bolus plus 600 mg/m² as a 22-hour infusion on days 1 and 2 every 2 weeks.
IROX: oxaliplatin 85 mg/m² plus irinotecan 200 mg/m² on day 1 every 3 weeks.

After an analysis of deaths within 60 days of study entry, the starting dose
of IFL was reduced. The current report, however, is based on patients enrolled
before that reduction. The primary endpoint was time to progression.

A total of 795 patients were included in this phase III trial analysis
(median age 61). They all had a histologic diagnosis of unresectable advanced
colorectal cancer and ECOG performance status 0 to 2 with adequate organ
function and life expectancy of 12 weeks or more. Minimum follow-up is 1 year.

Study Results

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