XELOX, as second-line therapy, was found to be as effective as the more commonly used FOLFOX treatment for patients whose cancer had already gotten worse on treatment with Camptosar® (irinotecan).

XELOX combines an oral drug Xeloda® (capecitabine) with Eloxatin® (oxaliplatin).  FOLFOX uses an infusional schedule of 5FU and leucovorin.

Researchers randomly compared XELOX to FOLFOX4 to treat 627 patients with metastatic colorectal cancer.  Patients had already received initial therapy with Camptosar and either had their cancer progress or were unable to tolerate the treatments.  Although outcomes were similar for the two regimens, side effects differed.

The team found:

• Median progression-free survival did not differ — 4.7 months with XELOX compared to 4.8 months with FOLFOX.
• Overall survival was also very similar — 11.9 months with XELOX and 12.5 months with FOLFOX.
• Serious lowered white counts (neutropenia) and fevers caused by low counts (febrile neutropenia) were more common with FOLFOX.  35 percent of patients on FOLFOX developed grade 3 or 4 neutropenia compared to 5 percent of those using XELOX.  Fever occurred in 4 percent of FOLFOX patients vs 1 percent on XELOX.
• Hand-foot syndrome was more common in patients on XELOX with 4 percent of patients experiencing a severe form of this side effect compared to 1 percent on FOLFOX.
• XELOX patients had more severe diarrhea:  19 percent versus 5 percent.

The international team of researchers, led by Dr. Mace Rothenberg from Vanderbilt-Ingram Cancer Center in Nashville, concluded,

XELOX is noninferior to FOLFOX-4 when administered as second-line treatment in patients with metastatic colorectal cancer.

SOURCE: Rothenberg et al., Annals of Oncology, online advance access June 10, 2008.