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Two Different First-Line Irinotecan Treatments Have Similar Results

Spanish researchers have found that patients treated every week with Camptosar® (irinotecan, CPT-11) plus a high dose of  continuous infusion 5-FU (fluorouracil) without leucovorin had similar outcomes to those treated with the more common biweekly FOLFIRI treatment that includes leucovorin.  FOLFIRI is Camptosar, 5-FU, and leucovorin.  The new treatment is called FUIRI.

In a randomized trial, patients received either FOLFIRI every two weeks or FUIRI weekly.  None had been treated for advanced (metastatic) colorectal cancer before.

In the study of 346 patients a comparison of FOLFIRI versus FUIRI found

  • Tumor shrinkage (response rates) were 57 percent for FOLFIRI and 51 percent for FUIRI.
  • Time until cancer worsened (progression-free survival) was 8.3 months for FOLFIRI and 8.4 months for FUIRI.
  • Median overall survival also wasn’t significantly different: 21.6 months versus 19.2 months.

Serious side effects differed between the two regimens with

  • Patients having low white cell counts (neutropenia) more often with FOLFIRI:  27 percent vs. 9 percent.
  • More diarrhea in the weekly FUIRI treatment:  21 percent for FOLFIRI vs 42 percent for FUIRI.

Members of the Spanish Cooperative Group for the Study of Digestive Tumors concluded,

FUIRI represents a valid alternative without leucovorin to the FOLFIRI regimen as metastatic colorectal cancer first-line treatment.

SOURCE: Aranda et. al, Annals of Oncology, Advance Access published online August 20, 2008.

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2 Comments

  1. Wendy Hammond said:

    Hello. I have talked with Dr. Heinz several times and am so grateful. My mother has stage 4 colon cancer of the colon mestasized to her liver. She is 59. She was diagnosed last March. She is now on CPT11 together with Leucovarin with 5FU as a push to take home every 2 weeks. She has a port and leaves it on for 3 days. I can’t seem to get an answer from her doctor. Is there hope for improvement? Survival? Is there anything that can possibly be done to cure this kind of cancer? I have read of people being cured here on this site. If there is no cure, please tell me or at least let me know the statistics. I am always reading about the 5 year survival rate but that does not help me. She doesn’t seem to be doing good. She is always extremely tired,says she tastes the chemo in her mouth, and has alot of pain. She takes vicodin is terribly constipated and her doctor won’t give her anything stronger. I am getting no answer. She does not believe in a second opinion. I do.Is it worth me asking her doctor for a KRAS test? Dr. Heinz ,I am so sorry to take up more of your time. I could not get all of the answers you asked for. Her doctor doesn’t seem to have any time for us. She can’t have surgery because she’s allergic to the dye that helps to see the tumors. Thank you for being so helpful I need to know I am doing all I possibly can. Wendy hammond

  2. Kate Murphy said:

    Wendy,

    First of all, unless your Mom has told him he can discuss her situation with you, the doctor just can’t tell you a lot. Ask your mother to give him permission to talk to you. Then ask him for some answers.

    We always urge an opinion from a team of doctors, including surgeons, radiologists, and medical oncologists in advanced (stage IV) cancers like your mom’s.

    Information about where her cancer has spread is very important. Patients who are allergic to x-ray dye can get scans without dye or with a type of dye that doesn’t cause allergic reactions. Allergy is not a good reason not to get more information.

    And information might save her life!

    While cures from advanced colorectal cancer using chemotherapy are very, very rare (probably don’t happen), surgery can and does cure stage IV colorectal cancer.

    If the tumors in her liver can be completely removed by a skilled surgeon, there is almost a 50 percent chance of being alive and cancer-free five years later.

    Chemotherapy can extend survival time — but cannot remove all signs of cancer. Eventually, the cancer will become resistant to a particular chemo and begin to grow again.

    Another reason why x-ray scanning is so important. When the tumor progresses (gets bigger or moves somewhere else), a different chemo treatment can help extend life.

    Finally, your mother does NOT need to be in pain. Vicodin is only one pain medicine. There are others that are stronger. She may need a stronger dose of a long acting pain medicine along with a fast acting drug when pain “breaks through.”

    I worry that your mother’s doctor isn’t hearing her concerns.

    Or, it is possible that she is trying to spare you worry and not telling you everything she hears. She also might not understand everything he says.

    Everybody needs an advocate, a second pair of ears and an extra voice, at the doctor’s when dealing with cancer. It is just too scary to do alone.

    Ask your mother if you can go with her to see the doctor, talk about a surgeon’s opinion, and make sure she gets the scans she needs.

    If you need more information, please call the C3 Answer Line at 1-877-4CRC-111.

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