Objectives: To report on the efficacy and safety of reduced-intensity FOLFOXIRI (RI-FOLFOXIRI) as salvage chemotherapy for patients with refractory metastatic colorectal cancer (mCRC).
Methods: From October 2009 to March 2014, a total of 45 patients with refractory mCRC received RI-FOLFOXIRI as salvage chemotherapy. The initial dose of RI-FOLFOXIRI was 85% of the dose last used for each drug. All patients received a 2-hour infusion of folinate, followed by a bolus of 5-fluorouracil, and then 2400 to 3000 mg/m2 for 46 hours; in addition, patients were either administered irinotecan on day 1 followed by oxaliplatin on day 3 (group A), oxaliplatin on day 1 followed by irinotecan on day 3 (group B), or irinotecan and oxaliplatin on day 1 (group C).
Results: Seven patients (15.6%) showed a partial response, and 15 patients (33.3%) had stable disease. The median progression-free and overall survival durations were 3.9 and 7.6 months, respectively. Patients who had wild-type K-RAS showed a longer overall survival duration (8.5 vs. 7.0 mo; P=0.04) but no difference in progression-free survival durations (4.4 vs. 3.4 mo; P=0.20) compared with patients with mutant K-RAS. The most common adverse events were neutropenia (28.9%) and diarrhea (26.7%).
Conclusions: RI-FOLFOXIRI as salvage chemotherapy is effective and enables management of patients with refractory mCRC.
*Department of Medicine, Division of Hematology and Oncology, Taoyuan Armed Forces General Hospital, Taoyuan County
Departments of †Medicine, Division of Hematology and Oncology
‡Surgery, Division of Colon and Rectum Surgery, Taipei Veterans General Hospital
§School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
H.W.T., Y.-T.L., and J.-K.L. designed the study. J.-K.J., S.-H.Y., and W.-S.C. performed the acquisition, analysis, and interpretation of data. C.-C.L. had been involved in drafting the manuscript. H.M.C. and H.W.T. wrote the manuscript with comments from all authors. All authors read and approved the final version of the manuscript.
The authors declare no conflicts of interest.
Reprints: Hao-Wei Teng, MD, PhD, Department of Medicine, Division of Hematology and Oncology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan 112, ROC. E-mail: danny_teng@yahoo.com.tw.
