Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment
Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment
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DOI：
10.1200/jco.2004.11.037
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发表时间：
2004-04-01
影响因子：
45.3
通讯作者：
Schmoll, HJ
中科院分区：
文献类型：
--
作者：
Grothey, A;Sargent, D;Schmoll, HJ
目的氟尿嘧啶（FU）-亚叶酸钙（LV）、伊立替康和奥沙利铂单独或联合治疗晚期结直肠癌（CRC）已被证明是有效的。FU-LV与伊立替康或奥沙利铂的联合方案目前被视为该疾病的标准一线治疗。然而，所有三种活性细胞毒性药物FU-LV、伊立替康和奥沙利铂的可用性对总生存期（OS）的重要性尚未评估。材料和方法我们分析了来自七个最近发表的晚期CRC的III期试验的数据，以将接受二线治疗的患者的百分比和接受所有三种药物的患者的百分比与报告的中位OS相关联，使用加权分析。ResultsThe报道的中位OS与在其疾病过程中接受所有三种药物的患者的百分比显著相关（P = 0.0008），但与接受任何二线治疗的患者的百分比无关（P = 0.19）。此外，使用联合方案作为一线治疗与中位生存期3.5个月的显著改善相关（95% CI，1.27 ~ 5.73个月; P = .0083）。结论我们的结果支持使这三种活性药物可用于所有晚期CRC患者的策略，这些患者是此类治疗的候选者，以最大化OS。此外，我们的研究结果表明，随着有效的补救方案的可用性，OS不应再被视为评估姑息性一线治疗CRC疗效的最合适终点。(C)2004年，美国临床肿瘤学会。
PurposeFluorouracil (FU)-leucovorin (LV), irinotecan, and oxaliplatin administered alone or in combination have proven effective in the treatment of advanced colorectal cancer (CRC). Combination protocols using FU-LV with either irinotecan or oxaliplatin are currently regarded as standard first-line therapies in this disease. However, the importance of the availability of all three active cytotoxic agents, FU-LV, irinotecan, and oxaliplatin, on overall survival (OS) has not yet been evaluated.Materials and MethodsWe analyzed data from seven recently published phase III trials in advanced CRC to correlate the percentage of patients receiving second-line therapy and the percentage of patients receiving all three agents with the reported median OS, using a weighted analysis.ResultsThe reported median OS is significantly correlated with the percentage of patients who received all three drugs in the course of their disease (P = .0008) but not with the percentage of patients who received any second-line therapy (P = .19). In addition, the use of combination protocols as first-line therapy was associated with a significant improvement in median survival of 3.5 months (95% Cl, 1.27 to 5.73 months; P = .0083).ConclusionOur results support the strategy of making these three active drugs available to all patients with advanced CRC who are candidates for such therapy to maximize OS. In addition, our findings suggest that, with the availability of effective salvage options, OS should no longer be regarded as the most appropriate end point by which to assess the efficacy of a palliative first-line treatment in CRC.(C) 2004 by American Society of Clinical Oncology.