High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer

Mattioli, Rodolfo; Massacesi, Cristian; Recchia, F.; Marcucci, F.; Cappelletti, C.; Imperatori, L.; Pilone, Alberta; Rocchi, Marco; Cesta, Alisia; Laici, G.; Bonsignori, M.; Lippe, P.

doi:10.1093/annonc/mdi222

Cited by 46 publications

(20 citation statements)

References 12 publications

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“…The cumulative dose-related toxicity is not easily reversible after treatment discontinuation. The transitory symptoms observed during and after therapy may be related to a reversible dysfunction of unmyelinated axons or to a disturbance of ionic (sodium) channels [8,9,10], while the impairment of vibrator senses, tendon reflexes and deep sensitivity is related to a distal sensory, symmetric neuropathy of axonal type, resembling platinum toxicity in the dorsal root ganglia [11,12,13,14,15]. L-OHP neurological toxicity has been estimated by other authors to be reversible within 4–6 months of discontinuation, thus distinguishing it from cisplatin-induced neuropathy that is progressive and not reversible.…”

Section: Discussionmentioning

confidence: 99%

Persistence of High-Dose Oxaliplatin-Induced Neuropathy at Long-Term Follow-Up

Pietrangeli¹,

et al. 2006

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Section: Discussionmentioning

confidence: 99%

Persistence of High-Dose Oxaliplatin-Induced Neuropathy at Long-Term Follow-Up

Pietrangeli¹,

et al. 2006

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“…Grade 2 and 3 sensory neuropathy occurred in 17% and 6% of cases, respectively. Bi-fractionated FOLFOX4 was highly active and it demonstrated reduced neurotoxicity [56] . In the Kim et al experience to minimize toxicity and improve compliance of chemotherapy in elderly patients, reduced dose intensity (mini-) FOLFOX4 regimen was used as a firstline palliative chemotherapy.…”

Section: Oxaliplatinmentioning

confidence: 96%

“…No treatment-related death occurred. In addition, early phase Ⅱ data for modified FOLFOX4 are available [56,57] . Responses and geriatric scales ADL and IADL were assessed every 6 cycles.…”

Section: Oxaliplatinmentioning

confidence: 99%

Role of chemotherapy and novel biological agents in the treatment of elderly patients with colorectal cancer

Rosati¹,

Bilancia²

2008

WJG

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Patients older than 65 years are the fastest growing segment of the cancer population. It is estimated that within 20 years over 75% of cases and 85% of deaths from colorectal cancer (CRC) will be in this setting. Concerns about cancer treatment in the elderly relate to comorbidities, which increase proportionally with age, physiological changes associated with aging which may influence drug metabolism and toxicity, and diminishing life expectancy, which particularly impacts decisions surrounding the benefits of adjuvant therapies. Over the last 10 years, significant improvements in the treatment of advanced CRC with combination therapy have been made. The randomized trials which have defined these improvements did not exclude elderly patients. However, the median age of patients in these trials has generally been approximately 60 years. Thus, it appears that some degree of selection is involved with younger and presumably fitter patients being the subjects in most of the pivotal trials. The availability of new molecularly targeted agents and newly improved existing agents has expanded the range of treatment options available. This variety gives greater flexibility in dealing with different subsets of patients, such as the elderly. However, some fit elderly patients seem to tolerate combination therapy reasonably well, while studies on unfit elderly subjects are needed.

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“…There is no data suggesting an initial dose reduction based on age alone when using any of the FOLFOX regimens, but patients with a severe decrease in glomerular filtration rate should be considered for have dose reduction as the kidneys eliminate 30-50% of oxaliplatin (Table 1). • For example, a 2005 Italian multi-center phase II study investigated the effects of first-line chemotherapy with bi-fractionated oxaliplatin/ 5-FU-based regimen in elderly patients with mCRC and a median age of 75 years, and found an overall response rate of 51%, a stabilization of disease was observed in 25% of patients and grade 3/4 toxicities of neutropenia in 32% of patients [13].…”

Section: Oxaliplatinmentioning

confidence: 99%

Treatment of Metastatic Colorectal Cancer in the Elderly

Nguyen¹,

Hwang²

2009

Curr. Treat. Options in Oncol.

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Metastatic colorectal cancer (CRC) is the second leading cause of cancer related mortality in the United States. The median age of patients at diagnosis is over 70, so as the American population ages, it can be expected that the incidence of CRC will also increase. There is limited prospective data regarding the safety and efficacy of chemotherapy in elderly patients with metastatic CRC. However, the data that are available suggest that elderly patients with a good performance status have a similar likelihood of response to currently available chemotherapy, though perhaps a somewhat higher likelihood of toxicities such as myelosuppression. This paper reviews the available data and recommendations for the treatment of this patient population.

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High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer

Abstract: The bi-fractionated delivery of oxaliplatin plus 5-FU/leucovorin demonstrated high antitumor activity in elderly patients with advanced colorectal cancer. Splitting oxaliplatin administration might reduce incidence of severe neuropathy, although this has to be confirmed by further studies.

Cited by 46 publications

References 12 publications

Persistence of High-Dose Oxaliplatin-Induced Neuropathy at Long-Term Follow-Up

Persistence of High-Dose Oxaliplatin-Induced Neuropathy at Long-Term Follow-Up

Role of chemotherapy and novel biological agents in the treatment of elderly patients with colorectal cancer

Treatment of Metastatic Colorectal Cancer in the Elderly

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