Capecitabine plus oxaliplatin for the first-line treatment of elderly patients with metastatic colorectal carcinoma: Final results of the Southern Italy Cooperative Oncology Group trial 0108

Pasquale Comelia, Donato Natale, Antonio Farris, Antonio Gambardella, Luigi Maiorino, Bruno Massidda, Rossana Casaretti, Salvatore Tafuto, Vito Lorusso, Silvana Leo, Michele Cannone

Research output: Contribution to journalArticle

Abstract

BACKGROUND. In patients with metastatic colorectal carcinoma (MCC), capecitabine has demonstrated a superior response rate (RR), equivalent disease progression-free (PFS) and overall survival (OS), and an improved overall tolerability profile compared with bolus 5-fluorouracil/leucovorin (5-FU/LV). The FOLFOX4 regimen, combining oxaliplatin with LV and bolus plus infusional 5-FU (LV5FU2), has been shown to improve RR and PFS versus LV5FU2, and it was more effective and less toxic than irinotecan plus bolus 5-FU/LV. Capecitabine (an oral fluoropyrimidine) may be an effective, well tolerated, and more convenient alternative to 5-FU/LV in combination with oxaliplatin, especially in older patients. METHODS. Elderly (≥ 70 years) patients with MCC were treated with a 3-weekly regimen of oxaliplatin at an initial dose of 85 mg/m 2 intravenously on Day 1 plus capecitabine 1000 mg/m2 orally twice daily from Days 2 to 15 (XELOX regimen). In the absence of Grade ≥ 2 hematologic toxicity, oxaliplatin was increased to 100 mg/m2 in the second cycle, and in the absence of Grade ≥ 2 nonhematologic adverse events during Cycle 2, capecitabine was increased to 1250 mg/m2 twice daily in the third and subsequent cycles. After the first 35 patients (first series), the treatment protocol was amended so that only an oxaliplatin increase to 110 mg/m2 and 130 mg/m2 during Cycles 2 and 3, respectively, was planned in the remaining 41 patients (second series). RESULTS. Seventy-six patients with a median age of 75 years (range, 70-82 years) entered the current study. In the first series, the oxaliplatin dose was increased in 18 (51%) patients, and the capecitabine dose was increased in 4 (11%) patients. In the second series, the oxaliplatin dose was increased to 110 mg/m2 in 26 (63%) patients, and to 130 mg/m2 in 19 (46%) patients. In all, 2 complete and 29 partial responses were observed, for an overall RR of 41% (95% confidence interval [CI], 30-53%). The median PFS was 8.5 months (95% CI, 6.7-10.3 months), and the median OS was 14.4 months (95% CI, 11.9-16.9 months). In a multivariate analysis, the presence of disease symptoms affected both PFS and OS, whereas OS also was independently affected by male gender and disease spread. Age had no independent effect on PFS or OS. Five percent of patients developed Grade a 3 hematologic toxicity during treatment, Grade 3 peripheral neuropathy occurred in 8% of patients, and severe hand-foot syndrome in 13% of patients. CONCLUSIONS. Fit elderly patients with MCC showed a good RR to XELOX with only mild toxicity observed in most patients. XELOX, should, therefore be considered as an important therapeutic option for elderly patients with MCC.

Original languageEnglish
Pages (from-to)282-289
Number of pages8
JournalCancer
Volume104
Issue number2
DOIs
Publication statusPublished - Jul 15 2005

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oxaliplatin
Italy
Colorectal Neoplasms
Therapeutics
Fluorouracil
Leucovorin
Survival
irinotecan
Capecitabine
Confidence Intervals

Keywords

  • Capecitabine
  • Colorectal carcinoma
  • Elderly patients
  • Metastatic
  • Oxaliplatin

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Capecitabine plus oxaliplatin for the first-line treatment of elderly patients with metastatic colorectal carcinoma : Final results of the Southern Italy Cooperative Oncology Group trial 0108. / Comelia, Pasquale; Natale, Donato; Farris, Antonio; Gambardella, Antonio; Maiorino, Luigi; Massidda, Bruno; Casaretti, Rossana; Tafuto, Salvatore; Lorusso, Vito; Leo, Silvana; Cannone, Michele.

In: Cancer, Vol. 104, No. 2, 15.07.2005, p. 282-289.

Research output: Contribution to journalArticle

Comelia, Pasquale ; Natale, Donato ; Farris, Antonio ; Gambardella, Antonio ; Maiorino, Luigi ; Massidda, Bruno ; Casaretti, Rossana ; Tafuto, Salvatore ; Lorusso, Vito ; Leo, Silvana ; Cannone, Michele. / Capecitabine plus oxaliplatin for the first-line treatment of elderly patients with metastatic colorectal carcinoma : Final results of the Southern Italy Cooperative Oncology Group trial 0108. In: Cancer. 2005 ; Vol. 104, No. 2. pp. 282-289.
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abstract = "BACKGROUND. In patients with metastatic colorectal carcinoma (MCC), capecitabine has demonstrated a superior response rate (RR), equivalent disease progression-free (PFS) and overall survival (OS), and an improved overall tolerability profile compared with bolus 5-fluorouracil/leucovorin (5-FU/LV). The FOLFOX4 regimen, combining oxaliplatin with LV and bolus plus infusional 5-FU (LV5FU2), has been shown to improve RR and PFS versus LV5FU2, and it was more effective and less toxic than irinotecan plus bolus 5-FU/LV. Capecitabine (an oral fluoropyrimidine) may be an effective, well tolerated, and more convenient alternative to 5-FU/LV in combination with oxaliplatin, especially in older patients. METHODS. Elderly (≥ 70 years) patients with MCC were treated with a 3-weekly regimen of oxaliplatin at an initial dose of 85 mg/m 2 intravenously on Day 1 plus capecitabine 1000 mg/m2 orally twice daily from Days 2 to 15 (XELOX regimen). In the absence of Grade ≥ 2 hematologic toxicity, oxaliplatin was increased to 100 mg/m2 in the second cycle, and in the absence of Grade ≥ 2 nonhematologic adverse events during Cycle 2, capecitabine was increased to 1250 mg/m2 twice daily in the third and subsequent cycles. After the first 35 patients (first series), the treatment protocol was amended so that only an oxaliplatin increase to 110 mg/m2 and 130 mg/m2 during Cycles 2 and 3, respectively, was planned in the remaining 41 patients (second series). RESULTS. Seventy-six patients with a median age of 75 years (range, 70-82 years) entered the current study. In the first series, the oxaliplatin dose was increased in 18 (51{\%}) patients, and the capecitabine dose was increased in 4 (11{\%}) patients. In the second series, the oxaliplatin dose was increased to 110 mg/m2 in 26 (63{\%}) patients, and to 130 mg/m2 in 19 (46{\%}) patients. In all, 2 complete and 29 partial responses were observed, for an overall RR of 41{\%} (95{\%} confidence interval [CI], 30-53{\%}). The median PFS was 8.5 months (95{\%} CI, 6.7-10.3 months), and the median OS was 14.4 months (95{\%} CI, 11.9-16.9 months). In a multivariate analysis, the presence of disease symptoms affected both PFS and OS, whereas OS also was independently affected by male gender and disease spread. Age had no independent effect on PFS or OS. Five percent of patients developed Grade a 3 hematologic toxicity during treatment, Grade 3 peripheral neuropathy occurred in 8{\%} of patients, and severe hand-foot syndrome in 13{\%} of patients. CONCLUSIONS. Fit elderly patients with MCC showed a good RR to XELOX with only mild toxicity observed in most patients. XELOX, should, therefore be considered as an important therapeutic option for elderly patients with MCC.",
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TY - JOUR

T1 - Capecitabine plus oxaliplatin for the first-line treatment of elderly patients with metastatic colorectal carcinoma

T2 - Final results of the Southern Italy Cooperative Oncology Group trial 0108

AU - Comelia, Pasquale

AU - Natale, Donato

AU - Farris, Antonio

AU - Gambardella, Antonio

AU - Maiorino, Luigi

AU - Massidda, Bruno

AU - Casaretti, Rossana

AU - Tafuto, Salvatore

AU - Lorusso, Vito

AU - Leo, Silvana

AU - Cannone, Michele

PY - 2005/7/15

Y1 - 2005/7/15

N2 - BACKGROUND. In patients with metastatic colorectal carcinoma (MCC), capecitabine has demonstrated a superior response rate (RR), equivalent disease progression-free (PFS) and overall survival (OS), and an improved overall tolerability profile compared with bolus 5-fluorouracil/leucovorin (5-FU/LV). The FOLFOX4 regimen, combining oxaliplatin with LV and bolus plus infusional 5-FU (LV5FU2), has been shown to improve RR and PFS versus LV5FU2, and it was more effective and less toxic than irinotecan plus bolus 5-FU/LV. Capecitabine (an oral fluoropyrimidine) may be an effective, well tolerated, and more convenient alternative to 5-FU/LV in combination with oxaliplatin, especially in older patients. METHODS. Elderly (≥ 70 years) patients with MCC were treated with a 3-weekly regimen of oxaliplatin at an initial dose of 85 mg/m 2 intravenously on Day 1 plus capecitabine 1000 mg/m2 orally twice daily from Days 2 to 15 (XELOX regimen). In the absence of Grade ≥ 2 hematologic toxicity, oxaliplatin was increased to 100 mg/m2 in the second cycle, and in the absence of Grade ≥ 2 nonhematologic adverse events during Cycle 2, capecitabine was increased to 1250 mg/m2 twice daily in the third and subsequent cycles. After the first 35 patients (first series), the treatment protocol was amended so that only an oxaliplatin increase to 110 mg/m2 and 130 mg/m2 during Cycles 2 and 3, respectively, was planned in the remaining 41 patients (second series). RESULTS. Seventy-six patients with a median age of 75 years (range, 70-82 years) entered the current study. In the first series, the oxaliplatin dose was increased in 18 (51%) patients, and the capecitabine dose was increased in 4 (11%) patients. In the second series, the oxaliplatin dose was increased to 110 mg/m2 in 26 (63%) patients, and to 130 mg/m2 in 19 (46%) patients. In all, 2 complete and 29 partial responses were observed, for an overall RR of 41% (95% confidence interval [CI], 30-53%). The median PFS was 8.5 months (95% CI, 6.7-10.3 months), and the median OS was 14.4 months (95% CI, 11.9-16.9 months). In a multivariate analysis, the presence of disease symptoms affected both PFS and OS, whereas OS also was independently affected by male gender and disease spread. Age had no independent effect on PFS or OS. Five percent of patients developed Grade a 3 hematologic toxicity during treatment, Grade 3 peripheral neuropathy occurred in 8% of patients, and severe hand-foot syndrome in 13% of patients. CONCLUSIONS. Fit elderly patients with MCC showed a good RR to XELOX with only mild toxicity observed in most patients. XELOX, should, therefore be considered as an important therapeutic option for elderly patients with MCC.

AB - BACKGROUND. In patients with metastatic colorectal carcinoma (MCC), capecitabine has demonstrated a superior response rate (RR), equivalent disease progression-free (PFS) and overall survival (OS), and an improved overall tolerability profile compared with bolus 5-fluorouracil/leucovorin (5-FU/LV). The FOLFOX4 regimen, combining oxaliplatin with LV and bolus plus infusional 5-FU (LV5FU2), has been shown to improve RR and PFS versus LV5FU2, and it was more effective and less toxic than irinotecan plus bolus 5-FU/LV. Capecitabine (an oral fluoropyrimidine) may be an effective, well tolerated, and more convenient alternative to 5-FU/LV in combination with oxaliplatin, especially in older patients. METHODS. Elderly (≥ 70 years) patients with MCC were treated with a 3-weekly regimen of oxaliplatin at an initial dose of 85 mg/m 2 intravenously on Day 1 plus capecitabine 1000 mg/m2 orally twice daily from Days 2 to 15 (XELOX regimen). In the absence of Grade ≥ 2 hematologic toxicity, oxaliplatin was increased to 100 mg/m2 in the second cycle, and in the absence of Grade ≥ 2 nonhematologic adverse events during Cycle 2, capecitabine was increased to 1250 mg/m2 twice daily in the third and subsequent cycles. After the first 35 patients (first series), the treatment protocol was amended so that only an oxaliplatin increase to 110 mg/m2 and 130 mg/m2 during Cycles 2 and 3, respectively, was planned in the remaining 41 patients (second series). RESULTS. Seventy-six patients with a median age of 75 years (range, 70-82 years) entered the current study. In the first series, the oxaliplatin dose was increased in 18 (51%) patients, and the capecitabine dose was increased in 4 (11%) patients. In the second series, the oxaliplatin dose was increased to 110 mg/m2 in 26 (63%) patients, and to 130 mg/m2 in 19 (46%) patients. In all, 2 complete and 29 partial responses were observed, for an overall RR of 41% (95% confidence interval [CI], 30-53%). The median PFS was 8.5 months (95% CI, 6.7-10.3 months), and the median OS was 14.4 months (95% CI, 11.9-16.9 months). In a multivariate analysis, the presence of disease symptoms affected both PFS and OS, whereas OS also was independently affected by male gender and disease spread. Age had no independent effect on PFS or OS. Five percent of patients developed Grade a 3 hematologic toxicity during treatment, Grade 3 peripheral neuropathy occurred in 8% of patients, and severe hand-foot syndrome in 13% of patients. CONCLUSIONS. Fit elderly patients with MCC showed a good RR to XELOX with only mild toxicity observed in most patients. XELOX, should, therefore be considered as an important therapeutic option for elderly patients with MCC.

KW - Capecitabine

KW - Colorectal carcinoma

KW - Elderly patients

KW - Metastatic

KW - Oxaliplatin

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