Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 24, No 18S (June 20 Supplement), 2006: 3505
© 2006 American Society of Clinical Oncology

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Abstract

Alternating versus continuous "FOLFIRI" in advanced colorectal cancer (ACC): A randomized "GISCAD" trial

Ospedali Riuniti, Bergamo, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy; Policlinico Universitario Umberto I, Roma, Italy; Ospedale Serbelloni, Gorgonzola (MI), Italy; Casa di Cura Poliambulanza, Brescia, Italy; A.O. S. Maria delle Croci, Ravenna, Italy; Ospedale S.Gerardo, Monza (MI), Italy; A.O. Ospedale Treviglio-Caravaggio, Treviglio, Italy; A.O. Ospedale S. Martino, Genova, Italy

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Background: In ACC "FOLFIRI" is one of the standard regimens and is able to obtain about 40% response rate (RR) with an overall survival (OS) of 17–18 months. Experimental studies (Sobrero, 2000) indicate that an alternating chemotherapy could delay the appearance of cell resistance and reduce the therapeutic load for patients (pts). Methods: In order to evaluate whether intermittent "FOLFIRI" (CPT-11: 180 mg/sqm d1 + l-folinic acid -FA: 100 mg/sqm in 2 hr + 5fluorouracil-5FU: 400 mg/sqm bolus + 600 mg/sqm 22 hr infusion, d 1 and 2 every 2 weeks, for 2 months on and 2 months off) (arm A) was at least as effective as continuous "FOLFIRI" (same regimen, every month) (arm B), until progression in both arms, 336 pts from 27 Centers were randomised from 7/2001 to 6/2005. The characteristics of pts were: median age 64 years (r 29–75), males 214 (63%), PS 0: 222 (66%), liver mets only 166 (49%), multiple mts including liver 80 (24%). Results: RR was 29% in arm A and 35% in arm B, with a median progression-free survival (PFS) of 8.8 and 7.3 months respectively (HR = 1.00, 95% CI: 0.74 - 1.36). At a median follow-up of 27 months, median overall survival (OS), the primary endpoint of the trial, was 16.9 months in arm A and 17.6 in arm B (HR = 1.11, 95% CI: 0.83 - 1.48). Toxicity was acceptable and similar in the 2 arms (WHO grade 3–4 toxicity: neutropenia in 12% pts, diarrhoea in 11%, nausea/vomiting in 4% and fatigue in 3%). Conclusions: Our results demonstrate that alternating "FOLFIRI" obtains the same survival as a continuous treatment, thus reducing the discomfort to pts and the economic costs.

No significant financial relationships to disclose.

Abstract presentation from the 2006 ASCO Annual Meeting