Activity of oxaliplatin and 5-fluorouracil/folinic acid (FOLFOX2) in elderly patients with simultaneous advanced colon (ACC) and Hormone refractory prostate cancer (HRPC)

Abstract

8241 Background. There is a likelihood of simultaneous colon and HRPC given the increased actual incidence of both cancers in elderly patients. HRPC has a high prevalence of epigenetic mismatch repair deficiency where oxaliplatin, unlike other alkylators, maintains activity. FOLFOX2 has been show active in HRPC (Droz JP, Ann Oncol 2003). We describe two cases of simultaneous advanced tumors treated with FOLFOX2. Methods. Two chemo-naïve patients with synchronous pathologically documented ACC and HRPC received the FOLFOX2 combination every 2 weeks (85 mg/m2 oxaliplatin with 400 mg/m2 bolus 5FU and 100 mg/m2 folinic acid day 1 followed by 2200 mg/m2 48h continuous infusion 5FU). Tumor response was evaluated clinically by ultrasound, CT-Scan and CEA. PSA was also used to assess the response of prostate cancer. Results. Two patients (pts) (PS 1; age:72 and 74) with measurable liver metastasis (colon cancer), non measurable but symptomatic bone metastasis (prostate cancer), and elevated baseline PSA values (12.5 and 255 ng/ml) were evaluable for toxicity and response. Pt 1 had 8 cycles and PT 2, 6 cycles; Grade 2 anemia, nausea, and weight loss were reported in both pts. Grade 3 asthenia was reported in one pt after 4 cycles. No peripheral neuropathy was reported. FOLFOX2 induced objective responses (60% and 70% tumor regression that lasted 8+ and 6 months) in colon cancer liver metastasis. Responses were associated with >50% sustained decrease in CEA levels in both pts. Chemotherapy was associated with pain relief and significant reductions of PSA values (90% decrease in one pt and normalization in the other). Duration of biological PSA responses was 3 months for one pt with partial PSA response and sustained for 8+ months in the pt with complete PSA response. Conclusion. Our clinical experience suggests that front-line FOLFOX2 chemotherapy is safe and active to control tumor progression of synchronous advanced colon and hormone-refractory prostate cancers in elderly males. No significant financial relationships to disclose.