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[Progress in development of chemotherapy of colorectal carcinoma]
1Abteilung Hämatologie/Onkologie, Medizinische Hochschule Hannover.
Background:
Despite its low antineoplastic activity 5-fluorouracil remains the most active compound for the treatment of patient with metastatic colorectal cancer.
Patients And Methods:
Within 5 consecutive trials (2 were randomized) 174 patients have been treated with bolus 5-FU 600 mg/m2 plus folinic acid 300 mg/m2 day 2 to 4 with or without dipyridamole 3 x 75 mg p.o. day 1 to 5; 74 patients with bolus 5-FU 300 to 350 mg/m2, folinic acid 200 mg/m2 and interferon 5 x 109 U/m2 s.c. day 1 to 5; 18 patients with PALA 250 mg/m2, MTX 250 mg/m2 day 1 and bolus FU 600 mg/m2 day 2 q day 14 and 86 patients with FU 2.6 g/m2 given as 24-h infusion plus interferon 3 x 10(9) Ul s.c. and 133 patients with FU 2.6 g/m2 given as 24-h infusion, folinic acid 500 mg/m2 as 2-h infusion with or without interferon 3 x 10(9) U s.c.
Results:
The response rate was 11 to 14% for the i.v. push schedules and 21 to 36% for the 24-h continuous infusion regimens. The responses lasted for a median of 4.5 months and 12 months, respectively, if bolus or infusion schedules were applied. Median time to tumor progression was 4.5 months and 7 months for continuous infusion. The median patient survival was 10 to 12.7 months (bolus regimens) and 13 to 15 months for infusional 5-FU schedules.
Conclusion:
By weekly high dose infusional 5-FU the response rate, response duration, time to tumor progression and patient survival may be prolonged especially when modulated by folinic acid compared to modulated bolus regimens. This retrospective comparison however needs to be confirmed by the intergroup trial of AIO (#1/95) and EORTC (#40952).