FOLFOX and FLOX Regimens for the Adjuvant Treatment of Resected Stage II and III Colon Cancer

Overview

Journal Cancer Invest

Specialty Oncology

Date 2008 Sep 18

PMID 18798075

Citations 31

Authors

Saima Sharif

Michael J OConnell

Greg Yothers

Samia Lopa

Norman Wolmark

Affiliations

Soon will be listed here.

Abstract

The MOSAIC trial showed that the use of adjuvant oxaliplatin and an infusional regimen of 5-FU/LV in the treatment of stage II/III colon cancer improved disease-free survival (DFS). The NSABP's C-07 trial evaluated the addition of oxaliplatin to a weekly Roswell Park regimen of bolus 5-FU/LV and found a similar improvement in DFS. The benefit of oxaliplatin appears to be independent of the 5-FU/LV regimen used. This paper reviews the efficacy and toxicities of these two regimens and is meant to serve as a guide for clinical practice.

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References

de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J . Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000; 18(16):2938-47. DOI: 10.1200/JCO.2000.18.16.2938. View

Wolmark N, Rockette H, Fisher B, Wickerham D, Redmond C, Fisher E . The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol. 1993; 11(10):1879-87. DOI: 10.1200/JCO.1993.11.10.1879. View

Land S, Kopec J, Cecchini R, Ganz P, Wieand H, Colangelo L . Neurotoxicity from oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: NSABP C-07. J Clin Oncol. 2007; 25(16):2205-11. DOI: 10.1200/JCO.2006.08.6652. View

Van Cutsem E, Peeters M, Siena S, Humblet Y, Hendlisz A, Neyns B . Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007; 25(13):1658-64. DOI: 10.1200/JCO.2006.08.1620. View

Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T . Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004; 350(23):2343-51. DOI: 10.1056/NEJMoa032709. View

Kuebler J, Colangelo L, OConnell M, Smith R, Yothers G, Begovic M . Severe enteropathy among patients with stage II/III colon cancer treated on a randomized trial of bolus 5-fluorouracil/leucovorin plus or minus oxaliplatin: a prospective analysis. Cancer. 2007; 110(9):1945-50. DOI: 10.1002/cncr.23013. View

Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A . Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004; 351(4):337-45. DOI: 10.1056/NEJMoa033025. View

de Gramont A, Bosset J, Milan C, Rougier P, Bouche O, Etienne P . 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. J Clin Oncol. 1997; 15(2):808-15. DOI: 10.1200/JCO.1997.15.2.808. View

Sargent D, Wieand H, Haller D, Gray R, Benedetti J, Buyse M . Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol. 2005; 23(34):8664-70. DOI: 10.1200/JCO.2005.01.6071. View

10.

Douillard J, Cunningham D, Roth A, Navarro M, James R, Karasek P . Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000; 355(9209):1041-7. DOI: 10.1016/s0140-6736(00)02034-1. View

11.

Goldberg R, Sargent D, Morton R, Fuchs C, Ramanathan R, Williamson S . A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2003; 22(1):23-30. DOI: 10.1200/JCO.2004.09.046. View

12.

Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W . Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004; 350(23):2335-42. DOI: 10.1056/NEJMoa032691. View

13.

Kuebler J, Wieand H, OConnell M, Smith R, Colangelo L, Yothers G . Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol. 2007; 25(16):2198-204. DOI: 10.1200/JCO.2006.08.2974. View

14.

Petrelli N, Rustum Y, Bruckner H, Stablein D . The Roswell Park Memorial Institute and Gastrointestinal Tumor Study Group phase III experience with the modulation of 5-fluorouracil by leucovorin in metastatic colorectal adenocarcinoma. Adv Exp Med Biol. 1988; 244:143-55. DOI: 10.1007/978-1-4684-5607-3_15. View