Is XELOX Equivalent to FOLFOX or Other Continuous-Infusion 5-Fluorouracil Chemotherapy in Metastatic Colorectal Cancer?

Abstract Continuous-infusion 5-fluorouracil (5-FU)/leucovorin (LV) and oxaliplatin is a frequently used regimen in metastatic colorectal cancer. Continuous-infusion 5-FU imposes constraints on patients and institutions. Oral fluoropyrimidines that mimic continuous-infusion 5-FU are now available and...

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Bibliographic Details
Published in:Clinical colorectal cancer 2008-05, Vol.7 (3), p.206-211
Main Authors: Douillard, Jean-Yves, Bennouna, Jaafar, Senellart, Helene
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Bevacizumab
Capecitabine
Colorectal Neoplasms - drug therapy
Colorectal Neoplasms - pathology
Deoxycytidine - administration & dosage
Deoxycytidine - analogs & derivatives
Deoxycytidine - therapeutic use
Fluoropyrimidines
Fluorouracil - administration & dosage
Fluorouracil - analogs & derivatives
Fluorouracil - therapeutic use
Gastroenterology and Hepatology
Hematology, Oncology and Palliative Medicine
Humans
Leucovorin - administration & dosage
Neoplasm Metastasis
Organoplatinum Compounds - administration & dosage
Oxaliplatin
Quality of Life
Randomized Controlled Trials as Topic
Survival Analysis
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Summary:Abstract Continuous-infusion 5-fluorouracil (5-FU)/leucovorin (LV) and oxaliplatin is a frequently used regimen in metastatic colorectal cancer. Continuous-infusion 5-FU imposes constraints on patients and institutions. Oral fluoropyrimidines that mimic continuous-infusion 5-FU are now available and can be combined with oxaliplatin. In addition, it has been shown in small randomized trials that oral fluoropyrimidines are preferred by patients. Several randomized trials have compared continuous-infusion 5-FU/oxaliplatin with the oral fluoropyrimidine capecitabine plus oxaliplatin. In all of these trials, noninferiority was demonstrated for the use of oral fluoropyrimidines on the predefined endpoints such as progression-free survival, overall survival, or response rate. In all trials, however, the hazard ratios were always in favor of the use of continuous-infusion 5-FU/LV even though noninferiority was demonstrated. This could question the need to use oral fluoropyrimidines instead of continuous-infusion 5-FU. Patient preference, quality of life, and cost of treatment could also be considered in this setting, wherein most of the patients are not in a curative situation.
ISSN:1533-0028
1938-0674
DOI:10.3816/CCC.2008.n.029