A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma.

Abstract

Seventy-four previously untreated patients with metastatic colorectal adenocarcinoma were prospectively randomized into one of three treatment regimens: (1) 5-fluorouracil (5-FU) 450 mg/m2 as an intravenous (IV) bolus daily for five days or toxicity, then 200 mg/m2 IV bolus every other day for six doses; (2) methotrexate (MTX) 50 mg/m2 in normal saline by IV infusion over four hours followed by an IV bolus of 5-FU 600 mg/m2. This was administered weekly for 4 weeks and then every 2 weeks. (3) Leucovorin 500 mg/m2 in a two-hour IV infusion of normal saline with 5-FU 600 mg/m2 as an IV bolus one hour after the Leucovorin began every week for 6 weeks. The combined complete and partial response rates in the three regimens were 11%, 5%, and 48%, respectively (P = .0009). The median duration of response in the 5-FU and Leucovorin regimen was 10 months. There was no statistically significant difference between the treatment regimens with respect to survival time (P = .6). Toxicity in the 5-FU and Leucovorin regimen was predominantly diarrhea (13 of 30 patients, 40%). In this regimen, eight of 13 patients (52%) who developed diarrhea not only required a dose reduction of 5-FU, but also hospitalization for IV hydration. The predominant toxicity in the 5-FU alone regimen and the 5-FU and MTX regimen was leukopenia. One drug-related death occurred in each regimen.

A phase I/II study of neoadjuvant chemotherapy with Pemetrexed (Alimta) in rectal cancer

“…The risk of higher grade toxicities was substantially lower. As a comparison Petrelli et al reported diarrhoea in 40% of the patients with 26% needing hospitalization for rehydration [23]. The 4/37 patients with a grade 3/4 neutropenia was less than the 17 % reported by Louvet et al in advanced colorectal cancer [24].…”

Surgical treatment of colorectal metastases to the liver

“…The most consistently active agent for this disease has been 5-fluorouracil (5-FU), and most regimens have been based on this agent (Table 2). [17][18][19][20][21][22][23][24][25] Few studies, and certainly none of the most recent studies, have specifically examined the role of systemic chemotherapy for resectable liver disease. However, it is clear that for most chemotherapeutic regimens, less than one third of patients with liver metastases have shown any response.…”

Serum miR-19a Predicts Resistance to FOLFOX Chemotherapy in Advanced Colorectal Cancer Cases

“…For the reason that therapeutic effectiveness diminished following the multiple-line chemotherapies because of drug resistance or the decreased tumor response, we make our decision in first-line treatment regimen with cautious consideration. According to the latest NCCN (The National Comprehensive Cancer Network) clinical practice guidelines in Oncology version 1.2013, five chemotherapy regimens including FOLFOX (Tournigand et al, 2004), FOLFIRI (Tournigand et al, 2004;Colucci et al, 2005), CapeOx (Cassidy et al, 2004;Porschen et al, 2007;Cassidy et al, 2008), infusional 5-FU/LV or capecitabine (Petrelli et al, 1987;Jager et al, 1996) and FOLFOXIRI (Souglakos et al, 2006;Falcone et al, 2007) are recommended as the first-line treatment in metastatic CRCs. FOLFOX is the most common regimen.…”