Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2023; 15(11): 1913-1924
Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.1913
Mitomycin C and capecitabine: An additional option as an advanced line therapy in patients with metastatic colorectal cancer
Gil Mullin, Michal Sternschuss, Yosef Landman, Aaron Sulkes, Baruch Brenner
Gil Mullin, Aaron Sulkes, Baruch Brenner, Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
Gil Mullin, Michal Sternschuss, Yosef Landman, Aaron Sulkes, Baruch Brenner, Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, Petah-Tikva 4941492, Israel
Author contributions: Brenner B, Sternschuss M, and Mullin G contributed to study design; Mullin G contributed to acquisition of data; Mullin G, Sternschuss M, Brenner B, Sulkes A, and Landman Y contributed to data analysis and interpretation; Mullin G, Sternschuss M, Brenner B, and Sulkes A contributed to manuscript writing; Mullin G, Sternschuss M, Brenner B, Sulkes A, and Landman Y contributed to final manuscript approval.
Institutional review board statement: The study was reviewed and approved by the Rabin Medical Center Institutional Review Board (Approval No. 0639-19-RMC).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at brennerb@clalit.org.il. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Baruch Brenner, MD, Professor, Institute of Oncology, Davidoff Cancer Center, Beilinson Campus, 39 Jabotinski Street, Petah-Tikva 4941492, Israel. brennerb@clalit.org.il
Received: May 23, 2023
Peer-review started: May 23, 2023
First decision: July 31, 2023
Revised: August 31, 2023
Accepted: October 11, 2023
Article in press: October 11, 2023
Published online: November 15, 2023
Processing time: 176 Days and 3.9 Hours
Abstract
BACKGROUND

In recent years survival of patients with metastatic colorectal cancer (mCRC), though still limited, has improved significantly; clearly, when the disease becomes refractory to standard regimens, additional treatment options are needed. Studies have shown that mitomycin C (MMC), an antitumor antibiotic, and capecitabine, a precursor of 5-fluorouracil, may act synergistically in combination. The efficacy of MMC/capecitabine has been demonstrated in the first-line setting, but only a few small studies have tested it in the advanced-line setting, with contradictory results.

AIM

To summarize our experience using MMC/capecitabine as an advanced line treatment for mCRC.

METHODS

A retrospective study was conducted at a tertiary medical center including all patients with histologically proven mCRC who were treated with MMC/capecitabine after at least two previous lines of standard chemotherapy in 2006-2020. Data on patient demographics and past medical history, laboratory, pathological, and radiological factors, and treatment and survival were collected from the files. Survival analyses were performed using the Kaplan-Meier method. The association of patient and tumor characteristics with treatment effectiveness and toxicity was evaluated with univariate and multivariate proportional hazard Cox regression analyses. P ≤ 0.05 was considered statistically significant.

RESULTS

The cohort consisted of 119 patients of median age 64 years (range 37-85). Patients received a median of 2 MMC/capecitabine cycles (range 0.5-9.0). Thirty-four patients (28.6%) experienced grade ≥ 3 toxicity, including 2 (1.7%) with grade 4; there was no drug-related mortality. The objective response rate was 0.8%, and the disease control rate, 24.4%. Median progression-free survival (PFS) was 2.1 mo (range 0.2-20.3), and median overall survival, 4.8 mo (range 0.2-27.5). The 6-month overall survival rate was 44%; 8.7% of patients remained progression-free. Factors associated with longer PFS were lower gamma-glutamyl transferase level (P = 0.030) and primary tumor location in the left colon (P = 0.017). Factors associated with longer overall survival were lower gamma-glutamyl transferase level (P = 0.022), left-colon tumor location (P = 0.044), low-to-moderate histological grade (P = 0.012), Eastern Cooperative Oncology Group performance status 0-1 (P = 0.036), and normal bilirubin level (P = 0.047).

CONCLUSION

MMC/capecitabine is an active, available, and relatively safe regimen for use beyond standard lines of therapy in mCRC. Several clinical and laboratory parameters can identify patients more likely to benefit.

Keywords: Colorectal cancer; Metastatic cancer; Chemotherapy; Mitomycin C/Capecitabine; Advanced line treatment

Core Tip: Survival with metastatic colorectal cancer has improved significantly. However, when the disease becomes refractory, patients are left with limited options. Mitomycin C (MMC) and capecitabine combination is a potential treatment option for metastatic colorectal cancer (mCRC) patients beyond standard lines of treatment. Only a few small studies have tested it in the advanced-line setting, with contradictory results. We present our experience using the MMC/capecitabine combination. Our findings suggest that MMC/capecitabine is a safe, generally well-tolerated regimen. Ours is the largest series on the use of MMC/capecitabine in refractory mCRC. We were able to identify well-defined subgroups which derived clinical benefit from this combination.