PORTLAND, OregonMedian survival for patients with advanced colorectal
cancer treated with front-line regimens that include irinotecan
(CPT-11,Camptosar) or oxaliplatin (Eloxatin) is approaching 3 years. "That is
an absolutely remarkable figure to me," said Charles D. Blanke, MD, in a review
of new approaches to colorectal cancer treatment. Dr. Blanke is director of the
gastrointestinal malignancies program at the Oregon Health Sciences University
Cancer Institute in Portland.
In regimens commonly used in the United States, irinotecan is usually given
weekly for 4 weeks, while in Europe, it is given every 3 weeks, but there is
little effect on toxicity, according to Dr. Blanke. "Basically, no matter how
you give irinotecan, the dose-limiting toxicities are the same: neutropenia and
grade 3/4 diarrhea," he said.
Median survival with irinotecan monotherapy is 8 to 12 months, but Dr.
Blanke said that irinotecan combination regimens are now producing much longer
median survival in both front-line and second-line therapy.
"Studies comparing irinotecan to best supportive care as second-line
treatment showed that irinotecan improved median survival by almost 3 months,
from 6.5 to 9.2 months. There was a dramatic difference in the survival curves,
and this was highly statistically significant," Dr. Blanke said.
A European trial randomizing patients to second-line treatment with
irinotecan or infusional fluorouracil (5-FU) improved survival from 8.5 months
to nearly 11 months, "a truly remarkable figure," Dr. Blanke said.
Full Doses in Combination