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Journal of Clinical Oncology, Vol 15, 808-815, Copyright © 1997 by American Society of Clinical Oncology


ARTICLES

Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with bimonthly high-dose leucovorin and fluorouracil bolus plus continuous infusion for advanced colorectal cancer: a French intergroup study

A de Gramont, JF Bosset, C Milan, P Rougier, O Bouche, PL Etienne, F Morvan, C Louvet, T Guillot, E Francois and L Bedenne
Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs (GERCOD), Hopital Saint-Antoine, Paris, France.

PURPOSE: This multicenter study compared the therapeutic ratio of a monthly schedule of low-dose leucovorin (LV) and fluorouracil (5-FU) bolus with a bimonthly schedule of high-dose LV and 5-FU bolus plus continuous infusion in patients with advanced colorectal cancer. PATIENTS AND METHODS: Of the 448 patients randomly assigned to treatment, 433 were assessable. Treatment A was a monthly regimen of intravenous (IV) LV 20 mg/m2 plus bolus 5-FU 425 mg/m2 for 5 days every 4 weeks. Treatment B was a bimonthly regimen of IV LV 200 mg/m2 as a 2- hour infusion followed by bolus 5-FU 400 mg/m2 and 22-hour infusion 5- FU 600 mg/m2 for 2 consecutive days every 2 weeks. Therapy was continued until disease progression. Second-line chemotherapy, which included 5-FU continuous infusion, was allowed in both arms. RESULTS: The response rates in 348 patients with measurable lesions were 14.4% (monthly regimen) and 32.6% (bimonthly regimen) (P = .0004). The median progression-free survival times were 22 weeks (monthly regimen) and 27.6 weeks (bimonthly regimen) (P = .0012). The median survival times were 56.8 weeks (monthly regimen) and 62 weeks (bimonthly regimen) (P = .067). Grade 3-4 toxicities occurred in 23.9% of patients in the monthly arm compared with 11.1% of those in the bimonthly arm (P = .0004). Patients in arm A more frequently experienced severe granulocytopenia (7.3% v 1.9%), diarrhea (7.3% v 2.9%), and mucositis (7.3% v 1.9%) than patients in arm B. CONCLUSION: The bimonthly regimen was more effective and less toxic than the monthly regimen and definitely increased the therapeutic ratio. However, there was no evidence of increased survival.
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J. J. Lee, T. M. Kim, S. J. Yu, D.-W. Kim, Y.-h. Joh, D.-Y. Oh, J. H. Kwon, T. Y. Kim, D. S. Heo, Y.-J. Bang, et al.
Single-agent Capecitabine in Patients with Metastatic Colorectal Cancer Refractory to 5-Fluorouracil/Leucovorin Chemotherapy
Jpn. J. Clin. Oncol., July 1, 2004; 34(7): 400 - 404.
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Ann OncolHome page
E. Mitry, J.-Y. Douillard, E. Van Cutsem, D. Cunningham, E. Magherini, D. Mery-Mignard, L. Awad, and P. Rougier
Predictive factors of survival in patients with advanced colorectal cancer: an individual data analysis of 602 patients included in irinotecan phase III trials
Ann. Onc., July 1, 2004; 15(7): 1013 - 1017.
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Ann OncolHome page
L. Cals, O. Rixe, E. Francois, R. Favre, L. Merad, G. Deplanque, A. Laadem, P. Juin, J. M. Bereder, D. Bernardini, et al.
Dose-finding study of weekly 24-h continuous infusion of 5-fluorouracil associated with alternating oxaliplatin or irinotecan in advanced colorectal cancer patients
Ann. Onc., July 1, 2004; 15(7): 1018 - 1024.
[Abstract] [Full Text] [PDF]


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NEJMHome page
T. Andre, C. Boni, L. Mounedji-Boudiaf, M. Navarro, J. Tabernero, T. Hickish, C. Topham, M. Zaninelli, P. Clingan, J. Bridgewater, et al.
Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer
N. Engl. J. Med., June 3, 2004; 350(23): 2343 - 2351.
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JCOHome page
J. Cassidy, J. Tabernero, C. Twelves, R. Brunet, C. Butts, T. Conroy, F. Debraud, A. Figer, J. Grossmann, N. Sawada, et al.
XELOX (Capecitabine Plus Oxaliplatin): Active First-Line Therapy for Patients With Metastatic Colorectal Cancer
J. Clin. Oncol., June 1, 2004; 22(11): 2084 - 2091.
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The OncologistHome page
E. Diaz-Rubio
New Chemotherapeutic Advances in Pancreatic, Colorectal, and Gastric Cancers
Oncologist, June 1, 2004; 9(3): 282 - 294.
[Abstract] [Full Text] [PDF]


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Jpn J Clin OncolHome page
Y. Kondo, M. Terashima, A. Sato, and T. Taguchi
A Pilot Phase II Study of Capecitabine in Advanced or Recurrent Colorectal Cancer
Jpn. J. Clin. Oncol., April 1, 2004; 34(4): 195 - 201.
[Abstract] [Full Text] [PDF]


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JCOHome page
Efficacy of Oral Adjuvant Therapy After Resection of Colorectal Cancer: 5-Year Results From Three Randomized Trials
J. Clin. Oncol., February 1, 2004; 22(3): 484 - 492.
[Abstract] [Full Text] [PDF]


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JCOHome page
C. Tournigand, T. Andre, E. Achille, G. Lledo, M. Flesh, D. Mery-Mignard, E. Quinaux, C. Couteau, M. Buyse, G. Ganem, et al.
FOLFIRI Followed by FOLFOX6 or the Reverse Sequence in Advanced Colorectal Cancer: A Randomized GERCOR Study
J. Clin. Oncol., January 15, 2004; 22(2): 229 - 237.
[Abstract] [Full Text] [PDF]


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JCOHome page
R. M. Goldberg, D. J. Sargent, R. F. Morton, C. S. Fuchs, R. K. Ramanathan, S. K. Williamson, B. P. Findlay, H. C. Pitot, and S. R. Alberts
A Randomized Controlled Trial of Fluorouracil Plus Leucovorin, Irinotecan, and Oxaliplatin Combinations in Patients With Previously Untreated Metastatic Colorectal Cancer
J. Clin. Oncol., January 1, 2004; 22(1): 23 - 30.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
A. D. Cohen and N. E. Kemeny
An Update on Hepatic Arterial Infusion Chemotherapy for Colorectal Cancer
Oncologist, December 1, 2003; 8(6): 553 - 566.
[Abstract] [Full Text] [PDF]


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JCOHome page
M. P. Goetz, C. Erlichman, A. J. Windebank, J. M. Reid, J. A. Sloan, P. Atherton, A. A. Adjei, J. Rubin, H. Pitot, E. Galanis, et al.
Phase I and Pharmacokinetic Study of Two Different Schedules of Oxaliplatin, Irinotecan, Fluorouracil, and Leucovorin in Patients With Solid Tumors
J. Clin. Oncol., October 15, 2003; 21(20): 3761 - 3769.
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JCOHome page
L. B. Saltz
Another Study of How to Give Fluorouracil?
J. Clin. Oncol., October 15, 2003; 21(20): 3711 - 3712.
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JCOHome page
C-H. Kohne, J. Wils, M. Lorenz, P. Schoffski, R. Voigtmann, C. Bokemeyer, M. Lutz, U. Kleeberg, K. Ridwelski, R. Souchon, et al.
Randomized Phase III Study of High-Dose Fluorouracil Given As a Weekly 24-Hour Infusion With or Without Leucovorin Versus Bolus Fluorouracil Plus Leucovorin in Advanced Colorectal Cancer: European Organization of Research and Treatment of Cancer Gastrointestinal Group Study 40952
J. Clin. Oncol., October 15, 2003; 21(20): 3721 - 3728.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
D. Fallik, F. Borrini, V. Boige, J. Viguier, S. Jacob, C. Miquel, J.-C. Sabourin, M. Ducreux, and F. Praz
Microsatellite Instability Is a Predictive Factor of the Tumor Response to Irinotecan in Patients with Advanced Colorectal Cancer
Cancer Res., September 15, 2003; 63(18): 5738 - 5744.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
H. J. Mackay, M. Hill, C. Twelves, R. Glasspool, T. Price, S. Campbell, A. Massey, M. A. Macham, M. Uzzel, S. M. Bailey, et al.
A phase I/II study of oral uracil/tegafur (UFT), leucovorin and irinotecan in patients with advanced colorectal cancer
Ann. Onc., August 1, 2003; 14(8): 1264 - 1269.
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JCOHome page
T. Andre, P. Colin, C. Louvet, E. Gamelin, O. Bouche, E. Achille, N. Colbert, C. Boaziz, P. Piedbois, N. Tubiana-Mathieu, et al.
Semimonthly Versus Monthly Regimen of Fluorouracil and Leucovorin Administered for 24 or 36 Weeks as Adjuvant Therapy in Stage II and III Colon Cancer: Results of a Randomized Trial
J. Clin. Oncol., August 1, 2003; 21(15): 2896 - 2903.
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JCOHome page
H. Hochster, A. Chachoua, J. Speyer, J. Escalon, A. Zeleniuch-Jacquotte, and F. Muggia
Oxaliplatin With Weekly Bolus Fluorouracil and Low-Dose Leucovorin as First-Line Therapy for Patients With Colorectal Cancer
J. Clin. Oncol., July 15, 2003; 21(14): 2703 - 2707.
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Ann OncolHome page
D. Fallik, M. Ychou, J. Jacob, P. Colin, J. F. Seitz, J. Baulieux, A. Adenis, J. Y. Douillard, P. Couzigou, R. Mahjoubi, et al.
Hepatic arterial infusion using pirarubicin combined with systemic chemotherapy: a phase II study in patients with nonresectable liver metastases from colorectal cancer
Ann. Onc., June 1, 2003; 14(6): 856 - 863.
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Ann OncolHome page
M. Ychou, T. Conroy, J. F. Seitz, S. Gourgou, A. Hua, D. Mery-Mignard, and A. Kramar
An open phase I study assessing the feasibility of the triple combination: oxaliplatin plus irinotecan plus leucovorin/ 5-fluorouracil every 2 weeks in patients with advanced solid tumors
Ann. Onc., March 1, 2003; 14(3): 481 - 489.
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JCOHome page
G. Masci, M. Magagnoli, P. A. Zucali, L. Castagna, C. Carnaghi, B. Sarina, V. Pedicini, M. Fallini, and A. Santoro
Minidose Warfarin Prophylaxis for Catheter-Associated Thrombosis in Cancer Patients: Can It Be Safely Associated With Fluorouracil-Based Chemotherapy?
J. Clin. Oncol., February 15, 2003; 21(4): 736 - 739.
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Ann OncolHome page
B. Glimelius, R. Ristamaki, M. Kjaer, P. Pfeiffer, T. Skovsgaard, K. M. Tveit, T. Linne, J. E. Frodin, B. Boussard, D. Oulid-Aissa, et al.
Irinotecan combined with bolus 5-fluorouracil and folinic acid Nordic schedule as first-line therapy in advanced colorectal cancer
Ann. Onc., December 1, 2002; 13(12): 1868 - 1873.
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Ann OncolHome page
C. Aschele, D. Debernardis, R. Bandelloni, S. Cascinu, V. Catalano, P. Giordani, S. Barni, D. Turci, G. Drudi, S. Lonardi, et al.
Thymidylate synthase protein expression in colorectal cancer metastases predicts for clinical outcome to leucovorin-modulated bolus or infusional 5-fluorouracil but not methotrexate-modulated bolus 5-fluorouracil
Ann. Onc., December 1, 2002; 13(12): 1882 - 1892.
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V Trillet-Lenoir, G Freyer, P Kaemmerlen, A Fond, O Pellet, C Lombard-Bohas, J L Gaudin, G Lledo, R Mackiewicz, M C Gouttebel, et al.
Assessment of tumour response to chemotherapy for metastatic colorectal cancer: accuracy of the RECIST criteria
Br. J. Radiol., November 1, 2002; 75(899): 903 - 908.
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Ann OncolHome page
P. Rougier, D. Lepille, J. Bennouna, A. Marre, M. Ducreux, L. Mignot, A. Hua, and D. Mery-Mignard
Antitumour activity of three second-line treatment combinations in patients with metastatic colorectal cancer after optimal 5-FU regimen failure: a randomised, multicentre phase II study
Ann. Onc., October 1, 2002; 13(10): 1558 - 1567.
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Ann OncolHome page
R. M. Goldberg, S. H. Kaufmann, P. Atherton, J. A. Sloan, A. A. Adjei, H. C. Pitot, S. R. Alberts, J. Rubin, L. L. Miller, and C. Erlichman
A phase I study of sequential irinotecan and 5-fluorouracil/leucovorin
Ann. Onc., October 1, 2002; 13(10): 1674 - 1680.
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Ann OncolHome page
N. Kemeny, W. Tong, M. Gonen, J. Stockman, C. Di Lauro, J. Teitcher, P. White, C. Price, L. Saltz, S. Sharma, et al.
Phase I study of weekly oxaliplatin plus irinotecan in previously treated patients with metastatic colorectal cancer
Ann. Onc., September 1, 2002; 13(9): 1490 - 1496.
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Cancer Res.Home page
S. Attoub, C. Rivat, S. Rodrigues, S. Van Bocxlaer, M. Bedin, E. Bruyneel, C. Louvet, M. Kornprobst, T. Andre, M. Mareel, et al.
The c-kit Tyrosine Kinase Inhibitor STI571 for Colorectal Cancer Therapy
Cancer Res., September 1, 2002; 62(17): 4879 - 4883.
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JCOHome page
J.-Y. Douillard, P. M. Hoff, J. R. Skillings, P. Eisenberg, N. Davidson, P. Harper, M. D. Vincent, B. C. Lembersky, S. Thompson, A. Maniero, et al.
Multicenter Phase III Study of Uracil/Tegafur and Oral Leucovorin Versus Fluorouracil and Leucovorin in Patients With Previously Untreated Metastatic Colorectal Cancer
J. Clin. Oncol., September 1, 2002; 20(17): 3605 - 3616.
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Ann OncolHome page
J. Taieb, E. Mitry, V. Boige, P. Artru, J. Ezenfis, T. Lecomte, M. C. Clavero-Fabri, J. N. Vaillant, P. Rougier, and M. Ducreux
Optimization of 5-fluorouracil (5-FU)/cisplatin combination chemotherapy with a new schedule of leucovorin, 5-FU and cisplatin (LV5FU2-P regimen) in patients with biliary tract carcinoma
Ann. Onc., August 1, 2002; 13(8): 1192 - 1196.
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J Oncol Pharm PractHome page
M. Rowe, J. W Valle, R. Swindell, L. Fitzsimmons, and R. D James
New face for a familiar friend: the deGramont regimen in the treatment of metastatic colorectal cancer given as an outpatient: a feasibility study
Journal of Oncology Pharmacy Practice, June 1, 2002; 8(2-3): 97 - 103.
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JCOHome page
A. Ravaioli, M. Marangolo, E. Pasquini, A. Rossi, D. Amadori, G. Cruciani, D. Tassinari, G. Oliverio, P. Giovanis, D. Turci, et al.
Bolus Fluorouracil and Leucovorin With Oxaliplatin as First-Line Treatment in Metastatic Colorectal Cancer
J. Clin. Oncol., May 15, 2002; 20(10): 2545 - 2550.
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Ann OncolHome page
S. Cascinu, F. Graziano, F. Ferrau, V. Catalano, C. Massacesi, D. Santini, R. R. Silva, S. Barni, A. Zaniboni, N. Battelli, et al.
Raltitrexed plus oxaliplatin (TOMOX) as first-line chemotherapy for metastatic colorectal cancer. A phase II study of the Italian Group for the Study of Gastrointestinal Tract Carcinomas (GISCAD)
Ann. Onc., May 1, 2002; 13(5): 716 - 720.
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JCOHome page
H. Cure, V. Chevalier, A. Adenis, N. Tubiana-Mathieu, G. Niezgodzki, F. Kwiatkowski, D. Pezet, B. Perpoint, B. Coudert, C. Focan, et al.
Phase II Trial of Chronomodulated Infusion of High-Dose Fluorouracil and l-Folinic Acid in Previously Untreated Patients With Metastatic Colorectal Cancer
J. Clin. Oncol., March 1, 2002; 20(5): 1175 - 1181.
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J Oncol Pharm PractHome page
M. Summerhayes
Capecitabine: a novel, orally administered, tumour-activated treatment for colorectal cancer
Journal of Oncology Pharmacy Practice, December 1, 2001; 7(4): 107 - 125.
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Jpn J Clin OncolHome page
T.-S. Yang, K.-C. Hsu, H.-M. Wang, and Y.-C. Lin
Phase II Study of a Weekly 8-Hour 5-Fluorouracil and Leucovorin Infusion for Patients with Advanced Colorectal Cancer: Dose Adjusted According to its Toxicity
Jpn. J. Clin. Oncol., December 1, 2001; 31(12): 610 - 615.
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JCOHome page
Y. Becouarn, E. Gamelin, B. Coudert, S. Negrier, J.-Y. Pierga, J.-L. Raoul, J. Provencal, O. Rixe, C. Krisch, C. Germa, et al.
Randomized Multicenter Phase II Study Comparing a Combination of Fluorouracil and Folinic Acid and Alternating Irinotecan and Oxaliplatin With Oxaliplatin and Irinotecan in Fluorouracil-Pretreated Metastatic Colorectal Cancer Patients
J. Clin. Oncol., November 15, 2001; 19(22): 4195 - 4201.
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JCOHome page
E. Van Cutsem, C. Twelves, J. Cassidy, D. Allman, E. Bajetta, M. Boyer, R. Bugat, M. Findlay, S. Frings, M. Jahn, et al.
Oral Capecitabine Compared With Intravenous Fluorouracil Plus Leucovorin in Patients With Metastatic Colorectal Cancer: Results of a Large Phase III Study
J. Clin. Oncol., November 1, 2001; 19(21): 4097 - 4106.
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NEJMHome page
E. V. Cutsem, J.-Y. Douillard, and C.-H. Kohne
Toxicity of Irinotecan in Patients with Colorectal Cancer
N. Engl. J. Med., November 1, 2001; 345(18): 1351 - 1352.
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The OncologistHome page
M. Borner, W. Scheithauer, C. Twelves, J. Maroun, and H. Wilke
Answering Patients' Needs: Oral Alternatives to Intravenous Therapy
Oncologist, August 1, 2001; 6(2008): 12 - 16.
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