Annals of Oncology Advance Access published online on June 9, 2006
Annals of Oncology, doi:10.1093/annonc/mdl119
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1 Division of Medical Oncology, Department of Oncology, Livorno, Italy
* To whom correspondence should be addressed. Background: We conducted two phase II trials evaluating the combination of 5-fluorouracil/folinic acid, oxaliplatin and irinotecan (FOLFOXIRI) as first-line treatment in 74 metastatic colorectal cancer patients. Results were very promising with an overall response rate of 71% and 72%, a median PFS of 10.4 and 10.8 months and an overall survival of 26.5 and 28.4 months, respectively. A concern about the use of all three active agents up-front is the possibility that this might limit, after progression, disease control with second-line treatments. Therefore, we conducted the present analysis to evaluate the outcome of second-line treatments in these 74 patients. Methods: Among the 71 patients so far progressed 54 (76%) received second line chemotherapy (23: FOLFIRI, 17: FOLFOXIRI, five: 5-FU protracted infusion, three: FOLFOX, three: 5-FU+MMC, two: CPT-11, one: CPT-11+LOHP, one: raltitrexed). Seventeen patients (24%) did not receive second line treatments: 10 because of deterioration of performance status (PS), four because of patient refusal and three because of death. Patients' characteristics at the time of second-line treatment were: M/F 36 of 18 patients, median age 64 yrs (range 44-75), ECOG PS Results: A median of 4.1 months of second-line chemotherapy per patient were administered (range 1-8). Overall response rate (52 out of 54 evaluable patients) was 33% and stable disease were 19 (37%). Median duration of response was 8.1 months. At a median follow up of 15.1 months from the start of salvage chemotherapy median PFS and overall survival were respectively 6.7 and 15.2 months. Conclusions: First-line FOLFOXIRI does not impair the possibility to obtain objective responses and delay tumor progression with second line treatments containing the same agents used in first-line.
Received February 1, 2006
Revised April 18, 2006
Accepted April 19, 2006
original article
First-line 5-fluorouracil/folinic acid, oxaliplatin and irinotecan (FOLFOXIRI) does not impair the feasibility and the activity of second line treatments in metastatic colorectal cancer
G. Masi 1 *,
L. Marcucci 1,
F. Loupakis 1,
E. Cerri 1,
C. Barbara 1,
S. Bursi 1,
G. Allegrini 1,
I. M. Brunetti 2,
R. Murr 2,
S. Ricci 2,
S. Cupini 3,
M. Andreuccetti 1,
and
A. Falcone 4
2 Division of Medical Oncology, Department of Oncology, Pisa, Italy
3 Division of Internal Medicine, Department of Oncology, Pontedera, Italy
4 Division of Medical Oncology, Department of Oncology, Livorno, Italy; Cattedra di Oncologia Medica, University of Pisa, Italy
G. Masi, E-mail: gl.masi{at}tin.it
Abstract 
1 21 (39%) patients, multiple sites of disease 33 (61%) patients.
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