title: Grade 3/4 neutropenia is a limiting factor in second-line FOLFIRI following FOLFOX4 failure in elderly patients with metastatic colorectal cancer.
abstract: Previous studies have reported improved outcomes for elderly patients with metastatic colorectal cancer (mCRC) treated with oxaliplatin or irinotecan as first-line chemotherapy. However, few studies regarding second-line chemotherapy with oxaliplatin or irinotecan are currenlty available. We analyzed retrospectively the efficacy and toxicity in elderly patients (median age, 74 years) treated with second-line FOLFIRI following first-line FOLFOX4 failure. From March 2005 to January 2008, 35 elderly patients with mCRC received first-line FOLFOX4 comprising leucovorin, 5-FU and oxaliplatin followed by second-line FOLFIRI comprising leucovorin, 5-FU and irinotecan. The median number of treatment courses with FOLFIRI was 5 (range 2-32). One patient responded to the treatment. The disease control rate was 38.2%. The median time to treatment failure was 3 months, and the median overall survival (OS) time from the beginning of first-line chemotherapy was 20.7 months. The incidence of grade 3/4 neutropenia was 71.4%, while febrile neutropenia was 11.4%. The incidence of non-hematological toxicity was low. The use of the three active drugs, 5-FU, oxaliplatin and irinotecan, in mCRC produced the longest OS in elderly as well as in younger patients. However, the elderly patients treated with second-line FOLFIRI had a high rate of hematological toxicity. Second-line FOLFIRI may therefore be used with caution in the elderly.
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo 135-8550, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kuboki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Mizunuma
authors.forename: Masato
authors.initials: M
authors.lastname: Ozaka
authors.forename: Mariko
authors.initials: M
authors.lastname: Ogura
authors.forename: Mitsukuni
authors.initials: M
authors.lastname: Suenaga
authors.forename: Eiji
authors.initials: E
authors.lastname: Shinozaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsusaka
authors.forename: Keishou
authors.initials: K
authors.lastname: Chin
authors.forename: Masaaki
authors.initials: M
authors.lastname: Matsuura
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hatake