title: Shifting to first-line regimen after previous failure of irinotecan and oxaliplatin containing chemotherapies in unresectable metastatic colorectal cancer: a retrospective study of case analysis.
abstract: OBJECTIVE
  Conventional use of FOLFIRI-FOLFOX or the reverse sequence is the optional regimen in metastatic unresectable colorectal cancer (CRC). We present our experience in chemotherapy (C/T) shifting to first-line regimen after previous failure of irinotecan and oxaliplatin containing regimens.
  
  
  METHODS
  A total of 48 patients with metastatic unresectable CRC were examined retrospectively. All the patients had both failure of a first-line C/T and a second-line C/T. Of these patients, 13 patients received C/T shifting to first-line regimen. Data were collected retrospectively.
  
  
  RESULTS
  Rate of disease control of 38.4% was achieved (five in 13 patients). In the positive disease control group, metastatic sites were all extra-hepatic (five patients). In the negative disease control group, hepatic metastatic rate was 62.5% (five in eight patients, P=0.044).
  
  
  CONCLUSIONS
  Even after previous failure of irinotecan and oxaliplatin containing C/T, we observe positive disease control response and survival benefit in selected patients with C/T shifting to the first-line regimen especially in extra-hepatic metastasis. The preliminary results are proposed to gain insight into the need for further investigations and large-scale studies.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan, Republic of China. ss851124@gmail.com
authors.forename: Chao-Wen
authors.initials: CW
authors.lastname: Hsu
authors.forename: Tai-Ming
authors.initials: TM
authors.lastname: King
authors.forename: Chieh-Hsin
authors.initials: CH
authors.lastname: Lin
authors.forename: Hsin-Tai
authors.initials: HT
authors.lastname: Wang
authors.forename: Wen-Chieh
authors.initials: WC
authors.lastname: Ou
authors.forename: Jui-Ho
authors.initials: JH
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002166:Camptothecin