Survival after oxaliplatin therapy of irinotecan-pretreated advanced colorectal cancer patients.
OBJECTIVE
The activity of oxaliplatin (OHP) and irinotecan (CPT) alone or in combination with 5-fluorouracil (5-FU) in advanced colorectal cancer is comparable, but there are limited data on the effectiveness of oxaliplatin in patients pretreated by irinotecan.


METHODS
We have analyzed retrospectively the survival of 77 consecutive advanced colorectal cancer patients treated with OHP after previous CPT therapy. Multivariate analysis was performed by Cox regression method, with the results expressed as hazard ratio (HR).


RESULTS
The median survival from the start of OHP therapy was 10.7 months (1-year survival 43%). The median survival was not reached in 10 patients treated by hepatic arterial infusion of OHP (>10.6 months). The median survival from the diagnosis of advanced/metastatic disease was 34.3 months. On multivariate analysis, hemoglobin <125g/L (HR=2.42), neutrophils <5200 per microL (HR=0.36), duration of advanced/metastatic disease <21 months (HR=2.40) and interval from last CPT administration <3 months (HR=0.27) were statistically significant (p<0.05) independent predictors of survival from the start of OHP treatment, but only hemoglobin (HR=2.07), neutrophils (HR=0.32) and CEA <100microg/L (HR=0.44) were independent predictors of survival from the last CPT. There were 4 treatment-induced deaths after combination of OHP and raltitrexed (TOMOX).


CONCLUSIONS
More than 40% of patients pretreated by irinotecan survived 1 year after start of OHP therapy. The therapy was similarly effective as a second or higher line of treatment. Hemoglobin levels and neutrophil count were independent factors associated with survival. The number of toxic deaths observed after TOMOX is alarming.
Melichar
Bohuslav
B
Department of Oncology & Radiotherapy Charles University Medical School Teaching Hospital, Hradec Králové, Czech Republic. melichar@fnhk.cz
Kohlová
Tereza
T
Vesely
Pavel
P
D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D000077146:Irinotecan; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010166:Palliative Care / Q000379:methods*; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin