Sequential versus combination chemotherapy for the treatment of advanced colorectal cancer (FFCD 2000–05): an open-label, randomised, phase 3 trial

Ducreux, Michel; Malka, David; Mendiboure, Jean; Etienne, Pierre-Luc; Texereau, Patrick; Auby, Dominique; Rougier, Philippe; Gasmi, Mohamed; Castaing, Marine; Abbas, Moncef; Michel, Pierre; Gargot, D.; Azzedine, A.; Lombard‐Bohas, Catherine; Geoffroy, Patrick; Denis, Bernard; Pignon, Jean-Pierre; Bedenne, Laurent; Bouché, Olivier

doi:10.1016/s1470-2045(11)70199-1

Cited by 134 publications

(90 citation statements)

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“…Trial Design and Quality All five trials [7][8][9][10][11] involved adult patients with advanced unresectable or metastatic colorectal cancer, and all compared a planned sequential chemotherapy strategy with an upfront combination chemotherapy ( Table i). None of the patients had received prior systemic therapy for advanced colorectal cancer.…”

Section: 31mentioning

confidence: 99%

“…All patients had a World Health Organization performance status in the range 0-2. Only three studies 7,8,10 reported median follow-up time. All trials were superiority trials.…”

Section: 31mentioning

confidence: 99%

“…The sequential arm in all the trials consisted of a first-line fluoropyrimidine [7][8][9][10][11] . The cairo 7 , fo c us 8 , and li f e 9 trials followed the upfront fluoropyrimidine monotherapy with second-line irinotecan monotherapy.…”

Section: 31mentioning

confidence: 99%

“…The ffcd 10 trial also included another combination chemotherapy regimen as third-line treatment. The combination chemotherapy arm in all the trials began with upfront combination chemotherapy, with nothing else planned to follow 8,11 , although further unplanned treatment with another combination regimen 7,10 or with monotherapy 9 could be instituted at the discretion of the treating physician 11 . The focus 8 trial had a third strategy called "deferred combination.…”

Section: 31mentioning

confidence: 99%

“…One of the studies reported loss to follow-up 10 , and one of the studies was terminated early 10 (data not shown; see the full guideline at https://www.cancercare.on.ca/common/pages/User File.aspx?fileId=295210).…”

Section: 31mentioning

confidence: 99%

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Strategies of Sequential Therapies in Unresectable Metastatic Colorectal Cancer: A Meta-Analysis

et al. 2014

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Background: Before the emergence of first-line combination chemotherapy, the standard of care for unresectable metastatic colorectal cancer (mCRC) was first-line monotherapy with modulated 5-fluorouracil. Several large phase III randomized controlled trials, now completed, have assessed whether a planned sequential chemotherapy strategy—beginning with fluoropyrimidine monotherapy until treatment failure, followed by another regimen (either monotherapy or combination chemotherapy) until treatment failure—could result in the same survival benefit produced with an upfront combination chemotherapy strategy, but with less toxicity for patients. Methods: The MEDLINE and EMBASE databases, and abstracts from meetings of the American Society for Clinical Oncology and the European Society for Medical Oncology, were searched for reports comparing a sequential strategy of chemotherapy with an upfront combination chemotherapy in adult patients with mcrc. Publications that reported efficacy or toxicity data (or both) were included. Results: The five eligible trials that were identified included 4532 patients. A meta-analysis of those trials demonstrates a statistically significant survival advantage for combination chemotherapy (hazard ratio: 0.92; 95% confidence interval: 0.86 to 0.99). However, the median survival advantage (3–6 weeks in most trials) is small and of questionable clinical significance. Three trials reported first-line toxicities. Upfront combination chemotherapy results in significantly more neutropenia, febrile neutropenia, thrombocytopenia, diarrhea, nausea, vomiting, and sensory neuropathy. Sequential chemotherapy results in significantly more hand–foot syndrome. Conclusions: Given the small survival advantage associated with upfront combination chemotherapy, planned sequential chemotherapy and upfront combination chemotherapy can both be considered treatment strategies. Treatment should be chosen on an individual basis considering patient and tumour characteristics, toxicity of each strategy, and patient preference.

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Section: 31mentioning

confidence: 99%

“…All patients had a World Health Organization performance status in the range 0-2. Only three studies 7,8,10 reported median follow-up time. All trials were superiority trials.…”

Section: 31mentioning

confidence: 99%