Effect of an Irinotencan, 5-Fluorouracil, and Leucovorin Combination Chemotherapy (FOLFIRI) in Metastatic Colorectal Cancer

Abstract

Purpose: Irinotecan is a recently developed active agent in colorectal cancer. The combination of irinotecan and 5-fluorouracil (5-FU)/lecovorin (LV), known as the FOLFIRI regimen, has been approved for patients with metastatic colorectal cancer. The purpose of this study was to assess the efficacy and toxicity of the FOLFIRI regimen in the treatment of metastatic colorectal cancer. Methods: We reviewed the records of 65 patients who had received the FOLFIRI regimen from Jan. 2002 to Dec. 2005. The combination chemotherapy consisted of irinotecan (150~180 mg/m on day 1, 15) as a 2~6 hour infusion followed by bolus infusion of 5-FU (400 mg/m) and continuous infusion of 5-FU (600 mg/m on days 1, 2, 15, 16), concurrently with LV (20 mg/m on day 1, 2, 15, 16) as a 2 hour infusion. Cycles were repeated in three-week intervals. Results: Of the 65 patients who had received the FOLFIRI regimen, 34 were male and 31 cases female. The median age was 54.4 years. The primary tumor sites were the colon in 29 cases (44.6%) and the rectum in 36 cases (56.4%). The metastatic sites were the liver in 33 cases (50.8%), the peritoneum in 21 (32.3%), the lung in 14 (21.5%), a lymph node in 4, and the pelvis in 2. Twenty-seven patients (41.5%) had received the combination chemotherapy as the first line. Of the patients who received more than 3 cycles, complete response was none. Partial responses were 3 (7.1%), stable disease status in 25 cases (59.5%) and progressive disease status in 14 cases (33.3%). The rate of progressive disease status for patients who had received FOLFIRI as the 2nd or the 3rd line were much higher than that of those who had received it as the 1st line chemotherapy. Early stops (<3 cycles) of chemotherapy were due to toxicity, such as nausea, as diarrhea, in 15 of 19 cases (78.9%). Conclusions: The objective response rate of FOLFIRI was 7.1% in metastatic colorectal cancers. Nausea, vomiting, and diarrhea were the main causes of intolerance to the chemotherapy in most of the patients. J Korean Soc Coloproctol 2007; 23:333-337