title: New drugs for colorectal cancer (irinotecan, oxaliplatin, raltitrexed) meet expectations in routine practice: a single center's experience before and after their introduction.
abstract: OBJECTIVE
  Treatment of metastatic colorectal cancer with new drugs (NDs) as oxaliplatin and irinotecan had improved response and survival. In order to check whether the promising achievements of the trials are obtained in routine clinical practice, we have reviewed retrospectively our results for two periods, before (period A: 1993-1995, n=63) and after (period B:1998-2000 n=103) the introduction of these NDs. Patients characteristics, treatment modalities, survival, and prognostic factors were compared.
  
  
  METHODS
  There were 74 women and 92 men, aged 60.8+/-11.6 yr, 7 patients received best supportive care only, 91 had synchronous metastasis.
  
  
  RESULTS
  Period B patients were older, with WHO score>1 more often, more adjuvant treatment, more metachronous metastasis, and NDs used more frequently (24% vs 59%). Median survival was similar (16 vs 15 mo). But when looking at the population aged<75 years with WHO score<2, median survival was 13 mo (period A) vs 21 mo (period B); survival at 1, 2, and 3 yr were respectively 59.5+/-8%, 16.2+/-6 %, 13.5+/-6 % vs 69.8+/-6%, 49.6+/-7%, 29.8+/-7%, p<0.01). In multiparametric analysis, factors correlated with survival were the absence of elevated serum alkaline phosphatase, a unique metastatic organ, and administration of NDs.
  
  
  CONCLUSIONS
  In our routine clinical experience the use of NDs for metastatic CRC has allowed a significant improvement in survival among patients with unresectable tumors.
authors.affiliation: Oncologie Médicale, Centre Eugène Marquis, 35042 - Rennes France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Egreteau
authors.forename: Eveline
authors.initials: E
authors.lastname: Boucher
authors.forename: Sophie
authors.initials: S
authors.lastname: de Guibert
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Raoul
mesh_terms: D000367:Age Factors; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D011379:Prognosis; D011799:Quinazolines / Q000627:therapeutic use*; D012189:Retrospective Studies; D016019:Survival Analysis; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D009944:Organoplatinum Compounds; D011799:Quinazolines; D013876:Thiophenes; D000077150:Oxaliplatin; D000077146:Irinotecan; C068874:raltitrexed; D002166:Camptothecin
references.citation: Ann Oncol. 2003;14 Suppl 2:ii13-6
references.pmid: 12810452
references.citation: Br Med Bull. 2002;64:127-40
references.pmid: 12421730
references.citation: J Clin Oncol. 1997 Feb;15(2):808-15
references.pmid: 9053508
references.citation: Eur J Cancer. 1993;29A(9):1280-4
references.pmid: 8343268
references.citation: Lancet. 1998 Oct 31;352(9138):1413-8
references.pmid: 9807987
references.citation: Br J Cancer. 1998;77 Suppl 2:15-21
references.pmid: 9579851
references.citation: J Clin Oncol. 2004 Jan 15;22(2):229-37
references.pmid: 14657227
references.citation: J Clin Oncol. 1989 Apr;7(4):425-32
references.pmid: 2926468
references.citation: Semin Oncol. 2002 Oct;29(5 Suppl 15):3-10
references.pmid: 12422303
references.citation: J Clin Oncol. 1998 Apr;16(4):1470-8
references.pmid: 9552054
references.citation: Lancet. 2000 Mar 25;355(9209):1041-7
references.pmid: 10744089
references.citation: Ann Surg. 2000 Apr;231(4):487-99
references.pmid: 10749608
references.citation: Ann Oncol. 1999 Jun;10(6):663-9
references.pmid: 10442188
references.citation: BMJ. 1993 Mar 20;306(6880):752-5
references.pmid: 7683942
references.citation: J Clin Oncol. 2000 Aug;18(16):2938-47
references.pmid: 10944126
references.citation: J Clin Oncol. 1992 Jun;10(6):896-903
references.pmid: 1534121
references.citation: Arch Surg. 1997 May;132(5):505-10; discussion 511
references.pmid: 9161393