Real-Life Effectivity of Dose Intensity Reduction of First-Line mFOLFIRI-Based Treatment of Metastatic Colorectal Cancers: Sometimes Less Is More

Abstract

Aim: The key purposes of the treatment of metastatic malignancies are to extend survival and maintain the quality of life. Recently it has been emphasized in the scientific literature that the maintenance of maximal dose intensity is not always beneficial. Method: We examined the effectiveness of first-line mFOLFIRI-based treatments used in mCRC indication in 515 patients, treated between 1 January 2013 and 31 December 2018 at the Department of Oncotherapy of the University of Pécs, on a basis of real-world retrospective data analysis. We studied the effect of decreased dose intensity treatment modifications on patient survival. Results: 45% of all patients achieved the optimal relative dose intensity (RDI) of 85%, and the median progression-free and overall survival (mPFS, mOS) were 199 and 578 days, compared to 322 and 743 days, (mPFS p < 0.0002, 1 y (year) PFS OR (odds ratio) 0.39 (95% CI: 0.26–0.56) and mOS p = 0.0781, 2 yrs OS OR 0.58 (95% CI: 0.39–0.85), respectively) in the group of patients not achieving the RDI of 85%. Conclusions: Decreased dose intensity did not reduce the effectiveness of treatment; in fact, there was a significant improvement in most of the analyzed parameters. The option of reduced dose intensity, which shows the same or even better results with less toxicity, should definitely be considered in the future palliative treatment of mCRC patients.

Effect of home‐based resistance training on chemotherapy relative dose intensity and tolerability in colon cancer: The FORCE randomized control trial

“…Multivariable linear regression was used to assess the difference between the RT and UC groups in mean percent RDI and logistic regression was used to examine the planned RDI cut points of <85% and <70% 7,29,30 in relation to study arm, with adjustment for all covariates used in randomization procedure. We conducted analyses stratified by a priori planned subgroups (treatment duration, sex, frailty status), and exploratory subgroups (age, randomization before or after chemotherapy start).…”

“…Capecitabine is mainly lipophilic 34–36 and thus primarily distributes in the fat mass, whereas 5‐FU is mainly hydrophilic 28 and primarily distributes in the lean mass. Oxaliplatin is often considered hydrophilic but may also have moderate lipophilicity 29 . Interestingly, for capatacibine, the UC group had a nonsignificant higher RDI versus the RT group.…”

“…Oxaliplatin is often considered hydrophilic but may also have moderate lipophilicity. 29 Interestingly, for capatacibine, the UC group had a nonsignificant higher RDI versus the RT group. This could be explained by the higher gain in fat versus lean mass seen in the UC, compared to RT (Table 3).…”

The Real-Life Impact of Primary Tumor Resection of Synchronous Metastatic Colorectal Cancer—From a Clinical Oncologic Point of View

“…We surveyed all data of the metastatic colorectal cancer patients treated at the Institute of Oncotherapy of the University of Pécs Clinical Centre between 1 January 2013 and 31 December 2018. We analyzed a lot of different patient-related, disease-specific and outcome parameters in every patient (e.g., patient-related data: age at mCRC diagnosis, sex, performance status; tumor-related data: localization; metastasis-related data: temporality (synchronous or metachronous), focality and localization of metastases; treatment-related data: primary tumor resection, type of chemotherapy; palliative radiotherapy of intrapelvic tumors; clinical outcome parameters: progression-free survival (PFS) and overall survival (OS), the reason of discontinuation of chemotherapy) [4,5].…”

“…Based on our large database, previously utilized for different real-world data cohort analyses [4,5], we tried to evaluate the real-world role of PTR in the treatment of synchronous metastatic colorectal cancer (smCRC). The study aimed to find the clinical situations where PTR may find its best place or where PTR should be avoided.…”