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Rechallenge chemotherapy as a third line treatment option for metastatic colorectal carcinoma

Year 2017, Volume: 9 Issue: 4, 163 - 169, 01.12.2017
https://doi.org/10.21601/ortadogutipdergisi.296006

Abstract

Objective: Currently, there is required effective option in third line therapy after irinotecan and oxaliplatin based regimen because of survival of metastatic colorectal carcinoma (mCRC) increase. A repeated chemotherapy regimen (rechallenge therapy) may be an option in selective patients.

Patients and Methods: Patients were rechallenged with irinotecan or oxaliplatin regimen as a third line therapy which was the same therapy that they received as the first line. Response Evaluation Criteria in Solid Tumors (RECIST) was used to retrospectively calculate tumor response and Kaplan Meier method to calculate survival.

Results: Forty-five patients were found to be eligible for this study. The median follow up duration was 29 months. Thirty-three patients (73%) had been lost during follow up. Of the rechallenge treatments, 23 (51%) patients were administered irinotecan and 22 (49%) oxaliplatin based regimens. Most patients had a good performans status as 0 or 1 and K-RAS wild-type was detected in 31 (69%) of the patients. The common toxicities were haematologic and gastrointestinal, mostly grade 1 and 2. Response rate was 8.9%, while 25 (55.5%) of the patients had stable disease. Clinical benefit rate was calculated as 64.4%. The median progression-free survival (PFS) as 6 months (95% CI: 4.68–9.55 months) and the median overall survival (OS) was found as 10 months (95% CI: 7.00–12.99 months).

Conclusions: The results of this study indicate that rechallenge treatment may be a right choice as a third line therapy for selected patients.



References

  • 1. Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol, 2007;25:4779-86.
  • 2. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med, 2004;350:2335-42.
  • 3. Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med, 2009;360:1408-17.
  • 4. Peeters M, Price TJ, Cervantes A, Sobrero AF, Ducreux M, Hotko Y, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol, 2010;28:4706-13.
  • 5. Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, 2013;381:303–12.
  • 6. Nielsen DL, Palshof JA, Larsen FO, Jensen BV, Pfeiffer P. A systematic review of salvage therapy to patients with metastatic colorectal cancer previously treated with fluorouracil, oxaliplatin and irinotecan +/- targeted therapy. Cancer Treat Rev, 2014;40:701-15.
  • 7. Jonker DJ, O’Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, et al. Cetuximab for the treatment of colorectal cancer. N Engl J Med, 2007;357:2040–8.
  • 8. Schwartzberg LS, Rivera F, Karthaus M, Fasola G, Canon JL, Hecht JR et al. PEAK: a randomized, multicenter phase II study panitumumab plus modified fluorouracil, leucovorin and oxaliplatin (mFOLFOX6) or bevacizumab plus mFOLFOX6 in patients with previously untreated, unresectable, wildtype KRAS exon 2 metastatic colorectal cancer. J Clin Oncol, 2014;32:2240-7.
  • 9. Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M et al. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol, 2014;25:1346-55.
  • 10. Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol, 2014;15:1065-75.
  • 11. Tonini G, Imperatori M, Vincenzi B, Frezza AM, Santini D. Rechallenge therapy and treatment holiday: different strategies in management of metastatic colorectal cancer. J Exp Clin Cancer Res. 2013;18:32:92.
  • 12. Maindrault-Goebel F, Tournigand C, André T, Carola E, Mabro M, Artru P et al. Oxaliplatin reintroduction in patients previously treated with leucovorin, fluorouracil and oxaliplatin for metastatic colorectal cancer. Ann Oncol, 2004;15:1210–14.
  • 13. Suenaga M, Mizunuma N, Matsusaka S. A phase II study of oxaliplatin reintroduction in patients pretreated with oxaliplatin and Irinotecan for advanced colorectal cancer (RE-OPEN study): reports of interim analysis [abstract]. J Clin Oncol, 2012;30:580.
  • 14. Kang BW, Kim TW, Lee JL, Ryu MH, Chang HM, Yu CS, et al. Bevacizumab plus FOLFIRI or FOLFOX as third-line or later treatment in patients with metastatic colorectal cancer after failure of 5-fluorouracil, irinotecan, and oxaliplatin: a retrospective analysis. Med Oncol, 2009;26:32–7.
  • 15. Ishiguro M, Watanabe T, Yamaguchi K, Satoh T, Ito H, Seriu T, et al. A Japanese post-marketing surveillance of cetuximab (Erbitux(R)) in patients with metastatic colorectal cancer. Jpn J Clin Oncol, 2012;42:287–94.
  • 16. Jensen BV, Schou JV, Johannesen HH. Cetuximab every second week with irinotecan in patients with metastatic colorectal cancer refractory to 5-FU, oxaliplatin, and irinotecan: KRAS mutation status and efficacy. ASCO Meet Abstr 2010;28:3573.
  • 17. Pfeiffer P, Nielsen D, Yilmaz M, Iversen A, Vejlø C, Jensen BV. Cetuximab and irinotecan as third line therapy in patients with advanced colorectal cancer after failure of irinotecan, oxaliplatin and 5-fluorouracil. Acta Oncol, 2007;46:697–701.
  • 18. Pfeiffer P, Nielsen D, Bjerregaard J, Qvortrup C, Yilmaz M, Jensen B. Biweekly cetuximab and irinotecan as third-line therapy in patients with advanced colorectal cancer after failure to irinotecan, oxaliplatin and 5-fluorouracil. Ann Oncol, 2008;19:1141–5.
  • 19. Sogabe S, Komatsu Y, Yuki S, Kusumi T, Hatanaka K, Nakamura M, et al. Retrospective cohort study on the safety and efficacy of bevacizumab with chemotherapy for metastatic colorectal cancer patients: the HGCSG0801 study. Jpn J Clin Oncol, 2011;41:490–7.
  • 20. Geva R, Vecchione L, Tejpar S, Piessevaux H, Van Cutsem E, Prenen H. Bevacizumab plus chemotherapy as salvage treatment in chemorefractory patients with metastatic colorectal cancer. Onco Targets Ther, 2013;6:53–8.

Metastatik kolorektal kanser hastalarında 3. basamak tedavi seçeneği: rechallenge kemoterapi

Year 2017, Volume: 9 Issue: 4, 163 - 169, 01.12.2017
https://doi.org/10.21601/ortadogutipdergisi.296006

Abstract



Amaç: Metastatik kolorektal kanser (mCRC) sağkalımı nedeniyle irinotekan ve oksaliplatin esaslı rejim sonrasında üçüncü basamak tedavide şu an etkili bir seçenek mevcut. Seçici hastalarda tekrarlayan bir kemoterapi rejimi (yeniden sorgulama terapisi) bir seçenek olabilir.

Hastalar ve Yöntemler: Hastalar, irinotekan veya oksaliplatin rejimi ile birinci basamakta elde edilenlerle aynı tedavi olan üçüncü basamak tedavisi ile tekrar değerlendirildi. Katı tümörlerde yanıt değerlendirme kriterleri (RECIST) geriye dönük olarak tümör cevabı ve Kaplan Meier yöntemini hesaplayıp sağkalımı hesapladı.

Bulgular: Kırk beş hasta bu çalışma için uygun bulunmuştur. Ortanca takip süresi 29 ay idi. Otuz üç hasta (% 73) takip sırasında kaybedildi. Yeniden direnç tedavilerinin 23'ünde (% 51) irinotekan ve 22 (% 49) oksaliplatin rejimi uygulandı. Çoğu hastada iyi performans durumu 0 veya 1, K-RAS yabani tip 31 hastada (% 69) tespit edildi. Genel toksisite, çoğunlukla grade 1 ve 2 olan hematolojik ve gastrointestinal idi. Yanıt oranı% 8.9 iken, 25 hastada (% 55.5) stabil hastalığa sahipti. Klinik fayda oranı% 64.4 olarak hesaplandı. Ortanca progresyonsuz sağkalım (PFS) 6 ay (% 95 CI: 4.68-9.55 ay) ve medyan genel sağkalım (OS) 10 ay olarak bulundu (% 95 CI: 7.00-12.99 ay).

Sonuçlar: Bu çalışmanın sonuçları, yeniden seçilme tedavisinin seçilen hastalar için üçüncü basamak tedavisi olarak doğru seçim olabileceğini göstermektedir.

References

  • 1. Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol, 2007;25:4779-86.
  • 2. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med, 2004;350:2335-42.
  • 3. Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med, 2009;360:1408-17.
  • 4. Peeters M, Price TJ, Cervantes A, Sobrero AF, Ducreux M, Hotko Y, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol, 2010;28:4706-13.
  • 5. Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, 2013;381:303–12.
  • 6. Nielsen DL, Palshof JA, Larsen FO, Jensen BV, Pfeiffer P. A systematic review of salvage therapy to patients with metastatic colorectal cancer previously treated with fluorouracil, oxaliplatin and irinotecan +/- targeted therapy. Cancer Treat Rev, 2014;40:701-15.
  • 7. Jonker DJ, O’Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, et al. Cetuximab for the treatment of colorectal cancer. N Engl J Med, 2007;357:2040–8.
  • 8. Schwartzberg LS, Rivera F, Karthaus M, Fasola G, Canon JL, Hecht JR et al. PEAK: a randomized, multicenter phase II study panitumumab plus modified fluorouracil, leucovorin and oxaliplatin (mFOLFOX6) or bevacizumab plus mFOLFOX6 in patients with previously untreated, unresectable, wildtype KRAS exon 2 metastatic colorectal cancer. J Clin Oncol, 2014;32:2240-7.
  • 9. Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M et al. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol, 2014;25:1346-55.
  • 10. Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol, 2014;15:1065-75.
  • 11. Tonini G, Imperatori M, Vincenzi B, Frezza AM, Santini D. Rechallenge therapy and treatment holiday: different strategies in management of metastatic colorectal cancer. J Exp Clin Cancer Res. 2013;18:32:92.
  • 12. Maindrault-Goebel F, Tournigand C, André T, Carola E, Mabro M, Artru P et al. Oxaliplatin reintroduction in patients previously treated with leucovorin, fluorouracil and oxaliplatin for metastatic colorectal cancer. Ann Oncol, 2004;15:1210–14.
  • 13. Suenaga M, Mizunuma N, Matsusaka S. A phase II study of oxaliplatin reintroduction in patients pretreated with oxaliplatin and Irinotecan for advanced colorectal cancer (RE-OPEN study): reports of interim analysis [abstract]. J Clin Oncol, 2012;30:580.
  • 14. Kang BW, Kim TW, Lee JL, Ryu MH, Chang HM, Yu CS, et al. Bevacizumab plus FOLFIRI or FOLFOX as third-line or later treatment in patients with metastatic colorectal cancer after failure of 5-fluorouracil, irinotecan, and oxaliplatin: a retrospective analysis. Med Oncol, 2009;26:32–7.
  • 15. Ishiguro M, Watanabe T, Yamaguchi K, Satoh T, Ito H, Seriu T, et al. A Japanese post-marketing surveillance of cetuximab (Erbitux(R)) in patients with metastatic colorectal cancer. Jpn J Clin Oncol, 2012;42:287–94.
  • 16. Jensen BV, Schou JV, Johannesen HH. Cetuximab every second week with irinotecan in patients with metastatic colorectal cancer refractory to 5-FU, oxaliplatin, and irinotecan: KRAS mutation status and efficacy. ASCO Meet Abstr 2010;28:3573.
  • 17. Pfeiffer P, Nielsen D, Yilmaz M, Iversen A, Vejlø C, Jensen BV. Cetuximab and irinotecan as third line therapy in patients with advanced colorectal cancer after failure of irinotecan, oxaliplatin and 5-fluorouracil. Acta Oncol, 2007;46:697–701.
  • 18. Pfeiffer P, Nielsen D, Bjerregaard J, Qvortrup C, Yilmaz M, Jensen B. Biweekly cetuximab and irinotecan as third-line therapy in patients with advanced colorectal cancer after failure to irinotecan, oxaliplatin and 5-fluorouracil. Ann Oncol, 2008;19:1141–5.
  • 19. Sogabe S, Komatsu Y, Yuki S, Kusumi T, Hatanaka K, Nakamura M, et al. Retrospective cohort study on the safety and efficacy of bevacizumab with chemotherapy for metastatic colorectal cancer patients: the HGCSG0801 study. Jpn J Clin Oncol, 2011;41:490–7.
  • 20. Geva R, Vecchione L, Tejpar S, Piessevaux H, Van Cutsem E, Prenen H. Bevacizumab plus chemotherapy as salvage treatment in chemorefractory patients with metastatic colorectal cancer. Onco Targets Ther, 2013;6:53–8.
There are 20 citations in total.

Details

Subjects Health Care Administration
Journal Section Original article
Authors

Ersin Özaslan

Oktay Bozkurt

Ayşe Ocak Duran This is me

Mevlude İnanç This is me

Metin Özkan This is me

Publication Date December 1, 2017
Published in Issue Year 2017 Volume: 9 Issue: 4

Cite

Vancouver Özaslan E, Bozkurt O, Duran AO, İnanç M, Özkan M. Metastatik kolorektal kanser hastalarında 3. basamak tedavi seçeneği: rechallenge kemoterapi. omj. 2017;9(4):163-9.

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