Published online Feb 24, 2019. doi: 10.5306/wjco.v10.i2.75
Peer-review started: October 17, 2018
First decision: November 27, 2018
Revised: December 31, 2018
Accepted: January 23, 2019
Article in press: January 23, 2019
Published online: February 24, 2019
Processing time: 128 Days and 9 Hours
The treatment of metastatic colorectal cancer (mCRC) relies of chemotherapy. The efficacy of the standard FOLFIRI-therapy could be improved by a modification of the regimen by splitting the dose of irinotecan on day 1 and day 3 in the FOLFIRI3 regimen.
To determine safety and efficacy of FOLFIRI3 regimen.
This is a monocentric retrospective study evaluating the efficacy and safety of the FOLFIRI3 regimen given alone or in combination with bevacizumab or aflibercept in patients with previously treated mCRC.
One hundred and fifty-three consecutive patients were included (18 treated with FOLFIRI3, 99 with FOLFIRI3 plus bevacizumab and 36 with FOLFIRI3 plus aflibercept). The overall response rate (ORR) and disease control rate were 51% and 62%, respectively. Similar ORRs were observed in all 3 cohorts. Median progression-free survival (PFS) and overall survival (OS) were 3.9 mo (95%CI: 3.2-4.9) and 9.4 mo (95%CI: 6.6-12), respectively. Median PFS and OS values were improved in the FOLFIRI3 plus aflibercept group. The most common grade 3-4 adverse events were diarrhoea (21.6%) and neutropenia (11.8%), and these toxicities were more frequent in the FOLFIRI3 plus aflibercept group. According to the multivariate Cox proportional model, previous surgery of metastasis and aflibercept were associated with outcomes.
The modification of the FOLFIRI regimen impacted treatment response of mCRC patients. The addition of an antiangiogenic agent, in particular aflibercept, enhanced the clinical benefit and improved survival.
Core tip: This retrospective study suggests that modified FOLFIRI with injection of irinotecan at day 1 and 3 is interesting for patients with previously treated metastatic colorectal cancer. Surprisingly the efficacy of the FOLFIRI3-aflibercept seems superior the FOLFIRI3 alone or in combination with bevacizumab. Prospective randomized trial comparing FOLFIRI-aflibercept to FOLFIRI3-aflibercept in second line are warranted.