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Randomized phase II studies in advanced colorectal carcinoma: a North Central Cancer Treatment Group study
Abstract:
5-FU, semustine (MeCCNU), triazinate (TZT), and razoxane (ICRF-159) have each shown activity against advanced colorectal cancer in studies by at least two investigative groups. Objective response rates, however, have been low, without evidence of increased patient survival. The hope of this study was that enhanced activity might result from giving these agents in two-drug combinations. There were 167 eligible and evaluable patients randomized among the programs: 5-FU at a dose of 500 mg/m2/day by iv push X 5 (F); 5-FU at a dose of 400 mg/m2/day iv X 5 plus TZT at a dose of 175 mg/m2/day iv X 3 (FT); 5-FU at a dose of 400 mg/m2/day plus ICRF-159 at a dose of 600 mg/m2/day orally X 3 (FI); MeCCNU at a dose of 150 mg/m2/day orally plus TZT at a dose of 200 mg/m2/day iv X 3 (MT); MeCCNU at a dose of 150 mg/m2 orally plus ICRF-159 at a dose of 500 mg/m2/day orally X 3 (MI); and ICRF-159 at a dose of 425 mg/m2/day orally X 3 plus TZT at a dose of 125 mg/m2/day iv X 3 (IT). Patients with limiting conditions (serum creatinine greater than 1.5 mg/dl or elevated bilirubin) were randomized among programs F, FI, and MI. Objective response rates by treatment arm were: F--13% (four of 31 patients); FT--13% (four of 31); FI--15% (four of 27); MT--11% (three of 28); MI--13% (four of 32); and IT--6% (one of 17). Response rates of combination arms were not significantly larger than those of 5-FU alone. With regard to survival, patients initially treated with 5-FU alone had the most favorable experience (median, 10.8 mos). Multivariate analysis showed the following factors to have a significant and independent influence on survival: Eastern Cooperative Oncology Group performance score, grade, site of indicator lesion, and the presence of 5-FU in the treatment regimen. Toxic effects most frequently seen were nausea, vomiting, thrombocytopenia, leukopenia, diarrhea, stomatitis, alopecia, and dermatitis. The incidence and severity of toxicity were roughly comparable among the six treatment arms.
Insights
This study investigated two-drug combinations for advanced colorectal cancer, finding no significant improvement in response rates or survival compared to 5-FU alone. Combination chemotherapy did not enhance outcomes for colorectal cancer patients.
Area of Science:
- Oncology
- Medical Oncology
- Clinical Cancer Research
Background:
- Advanced colorectal cancer treatment has limited options.
- Previous agents like 5-FU, semustine (MeCCNU), triazinate (TZT), and razoxane (ICRF-159) showed activity but low response rates.
- Combination chemotherapy is explored to enhance treatment efficacy.
Purpose of the Study:
- To evaluate the efficacy of two-drug combinations of 5-FU, MeCCNU, TZT, and ICRF-159 in advanced colorectal cancer.
- To determine if combination therapy improves objective response rates and patient survival compared to single-agent therapy.
Main Methods:
- A randomized trial involving 167 eligible patients with advanced colorectal cancer.
- Patients were assigned to various treatment arms: 5-FU alone, or combinations of 5-FU, MeCCNU, TZT, and ICRF-159.
- Objective response rates and survival data were collected and analyzed.
Main Results:
- Objective response rates were low across all arms, with no significant difference between combination arms and 5-FU alone (ranging from 6% to 15%).
- Patients receiving 5-FU alone showed the most favorable survival experience (median 10.8 months).
- Multivariate analysis identified performance score, grade, lesion site, and 5-FU use as significant survival factors.
Conclusions:
- Two-drug combinations of 5-FU, MeCCNU, TZT, and ICRF-159 did not demonstrate enhanced activity or survival benefits over 5-FU monotherapy in advanced colorectal cancer.
- The presence of 5-FU in the regimen was a significant factor for improved survival.
- Toxicity profiles were comparable across treatment arms, with common side effects including nausea, vomiting, and myelosuppression.