title: FOLFOX alternated with FOLFIRI as first-line chemotherapy for metastatic colorectal cancer.
abstract: BACKGROUND
  5-fluorouracil (5-FU), irinotecan, and oxaliplatin are the most active drugs in advanced colorectal cancer (CRC), and survival is improved with patient exposure to all of them. The efficacy and safety of an alternating schedule of continuous-infusion 5-FU with leucovorin (LV) plus oxaliplatin (ie, FOLFOX regimen) or irinotecan (ie, FOLFIRI regimen) was assessed in the first-line setting.
  
  
  METHODS
  Seventy-nine patients with previously untreated, unresectable CRC were included. Treatment consisted of 5-FU/LV (de Gramont schedule) plus oxaliplatin (85 mg/m2) alternated biweekly with the same 5-FU/LV regimen plus irinotecan (180 mg/m2). Treatment was maintained until tumor progression or unacceptable toxicity was noted.
  
  
  RESULTS
  Median age was 62 years. Performance status was 0/1 in 91% of patients, 63% had 1 organ involved, and 80% had liver metastases. A median of 6 courses per patient (range, 1-9) and a total of 952 infusions were given. The most frequent grade 3/4 toxic events were neutropenia (32%), diarrhea (26%), and asthenia (7%). Grade 1/2 neurotoxicity was seen in 59% of cases, but no grade 3/4 neurotoxicity was observed. There were no toxic deaths. An objective response rate of 54% (4 complete responses plus 39 partial responses) was attained. Median time to progression and overall survival were 13 months and 18 months, respectively.
  
  
  CONCLUSIONS
  This alternating schedule is active, with efficacy results similar to those seen with sequential protocols, the advantages of less toxicity, and 100% patient exposure to irinotecan and oxaliplatin.
authors.affiliation: Servicio de Oncología Médica, Hospital Universitario La Fe, Avda. Campanar 21, E-46009 Valencia, Spain. japariciou@seom.org
authors.forename: Jorge
authors.initials: J
authors.lastname: Aparicio
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-Martos
authors.forename: Jose M
authors.initials: JM
authors.lastname: Vincent
authors.forename: Immaculada
authors.initials: I
authors.lastname: Maestu
authors.forename: Cristina
authors.initials: C
authors.lastname: Llorca
authors.forename: Isabel
authors.initials: I
authors.lastname: Busquier
authors.forename: Jan M
authors.initials: JM
authors.lastname: Campos
authors.forename: Daniel
authors.initials: D
authors.lastname: Perez-Enguix
authors.forename: Miquel
authors.initials: M
authors.lastname: Balcells
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000008:administration & dosage
chemical_list: D009944:Organoplatinum Compounds; D014803:Vitamin B Complex; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin