Modified 5-fluorouracil/leucovorin/irinotecan as a feasible and efficacious second-line chemotherapeutic regimen in advanced gastric cancers

Anant Ramaswamy; Vikas Ostwal; Kushal Gupta; Vijai Simha; Anup Toshniwal; Nitin Shetty; Chaitali Nashikkar; Sarika Mandavkar; Sudeep Gupta

doi:10.4103/sajc.sajc_232_17

South Asian Journal of Cancer, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · South Asian J Cancer 2018; 07(04): 219-222
DOI: 10.4103/sajc.sajc_232_17

ORIGINAL ARTICLE: GI Cancers

Modified 5-fluorouracil/leucovorin/irinotecan as a feasible and efficacious second-line chemotherapeutic regimen in advanced gastric cancers

Autor*innen

Anant Ramaswamy

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Vikas Ostwal

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Kushal Gupta

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Vijai Simha

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Anup Toshniwal

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Nitin Shetty

Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra
Chaitali Nashikkar

Department of GIDMG, Tata Memorial Hospital, Mumbai, Maharashtrar
Sarika Mandavkar

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Sudeep Gupta

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra

Abstract

als PDF herunterladen

Abstract

Background: Modified 5-fluorouracil/leucovorin/irinotecan (mFOLFIRI) is a commonly used combination second-line chemotherapeutic regimen in advanced gastric cancer (AGC). Materials and Methods: Patients diagnosed with AGC, receiving biweekly mFOLFIRI between July 2013 and June 2016, as second-line chemotherapy were retrospectively analyzed for tolerance, prognostic factors, event-free survival (EFS), and overall survival (OS). Results: Overall, 91 patients were administered a median of 6 cycles of therapy. Response rate was 29.7% and clinical benefit rate was 57.2%. With a median follow-up of 11.5 months, median EFS was 3.98 months (95% confidence interval [CI]: 2.54–5.41) and median OS was 7.73 months (95% CI: 5.30–10.15). Common Grade 3 and Grade 4 adverse events were neutropenia (18.7%), febrile neutropenia (9.9%), thrombocytopenia (7.7%), and vomiting (4.4%). Nearly 33% of patients required dose modification during therapy. Conclusions: mFOLFIRI regimen as a second-line therapy in AGCs appears feasible and efficacious in clinical practice.

Key words

Advanced gastric cancers - modified 5-fluorouracil/leucovorin/irinotecan - second-line chemotherapy

PDF (519 kb)

Referenzen

References
1 Kim R, Tan A, Choi M, El-Rayes BF. Geographic differences in approach to advanced gastric cancer: Is there a standard approach? Crit Rev Oncol Hematol 2013;88:416-26.
2 Mohammad NH, ter Veer E, Ngai LL, Mali R, van Oijen MG, Laarhoven HW. First-line doublet or triplet chemotherapy for advanced esophagogastric cancer: A systematic review and meta-analysis. J Clin Oncol 2015;33 Suppl:e15090. Available from: http://www.meetinglibrary.asco.org/content/146137-156. [Last accessed on 2016 Nov 03].
3 Diaz-Guardamino IE, Carmona-Bayonas A, Fonseca PJ, Martin AJ, Lorenzo ML, Custodio A, et al. First-line triplet or doublet chemotherapy for advanced gastric cancer: Analysis of 970 patients from a community practice registry. Ann Oncol 2016;27 Suppl 6:626P.
4 Hironaka S, Ueda S, Yasui H, Nishina T, Tsuda M, Tsumura T, et al. Randomized, open-label, phase III study comparing irinotecan with paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior combination chemotherapy using fluoropyrimidine plus platinum: WJOG 4007 trial. J Clin Oncol 2013;31:4438-44.
5 Kang JH, Lee SI, Lim DH, Park KW, Oh SY, Kwon HC, et al. Salvage chemotherapy for pretreated gastric cancer: A randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol 2012;30:1513-8.
6 Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K, et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer – A randomised phase III study of the arbeitsgemeinschaft internistische onkologie (AIO). Eur J Cancer 2011;47:2306-14.
7 Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): An international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2014;383:31-9.
8 Ford HE, Marshall A, Bridgewater JA, Janowitz T, Coxon FY, Wadsley J, et al. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): An open-label, phase 3 randomised controlled trial. Lancet Oncol 2014;15:78-86.
9 Higuchi K, Tanabe S, Shimada K, Hosaka H, Sasaki E, Nakayama N, et al. Biweekly irinotecan plus cisplatin versus irinotecan alone as second-line treatment for advanced gastric cancer: A randomised phase III trial (TCOG GI-0801/BIRIP trial). Eur J Cancer 2014;50:1437-45.
10 Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): A double-blind, randomised phase 3 trial. Lancet Oncol 2014;15:1224-35.
11 Sym SJ, Hong J, Park J, Cho EK, Lee JH, Park YH, et al. Arandomized phase II study of biweekly irinotecan monotherapy or a combination of irinotecan plus 5-fluorouracil/leucovorin (mFOLFIRI) in patients with metastatic gastric adenocarcinoma refractory to or progressive after first-line chemotherapy. Cancer Chemother Pharmacol 2013;71:481-8.
12 Maugeri-Saccà M, Pizzuti L, Sergi D, Barba M, Belli F, Fattoruso S, et al. FOLFIRI as a second-line therapy in patients with docetaxel-pretreated gastric cancer: A historical cohort. J Exp Clin Cancer Res 2013;32:67.
13 Assersohn L, Brown G, Cunningham D, Ward C, Oates J, Waters JS, et al. Phase II study of irinotecan and 5-fluorouracil/leucovorin in patients with primary refractory or relapsed advanced oesophageal and gastric carcinoma. Ann Oncol 2004;15:64-9.
14 Guimbaud R, Louvet C, Ries P, Ychou M, Maillard E, André T, et al. Prospective, randomized, multicenter, phase III study of fluorouracil, leucovorin, and irinotecan versus epirubicin, cisplatin, and capecitabine in advanced gastric adenocarcinoma: A French intergroup (Fédération francophone de cancérologie digestive, fédération nationale des centres de lutte contre le cancer, and groupe coopérateur multidisciplinaire en oncologie) study. J Clin Oncol 2014;32:3520-6.
15 Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47.
16 Arrieta O, Michel Ortega RM, Villanueva-Rodríguez G, Serna-Thomé MG, Flores-Estrada D, Diaz-Romero C, et al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: A prospective study. BMC Cancer 2010;10:50.
17 Seo SH, Kim SE, Kang YK, Ryoo BY, Ryu MH, Jeong JH, et al. Association of nutritional status-related indices and chemotherapy-induced adverse events in gastric cancer patients. BMC Cancer 2016;16:900.
18 Kim SG, Oh SY, Kwon HC, Lee S, Kim JH, Kim SH, et al. Aphase II study of irinotecan with bi-weekly, low-dose leucovorin and bolus and continuous infusion 5-fluorouracil (modified FOLFIRI) as salvage therapy for patients with advanced or metastatic gastric cancer. Jpn J Clin Oncol 2007;37:744-9.
19 Sym SJ, Ryu MH, Lee JL, Chang HM, Kim TW, Lee SS, et al. Salvage chemotherapy with biweekly irinotecan, plus 5-fluorouracil and leucovorin in patients with advanced gastric cancer previously treated with fluoropyrimidine, platinum, and taxane. Am J Clin Oncol 2008;31:151-6.
20 Lam SW, Wai M, Lau JE, McNamara M, Earl M, Udeh B, et al. Cost-effectiveness analysis of second-line chemotherapy agents for advanced gastric cancer. Pharmacotherapy 2017;37:94-103.