Abstract
Fluorouracil combined with oxaliplatin (FOLFOX) and fluorouracil combined with irinotecan (FOLFIRI) are both first-line clinical chemotherapy regimens. However, clinicians' selection of FOLFIRI or FOLFOX medication regimens and their effects on patients' health outcomes are not clear. The aim of this study was to evaluate the impacts on patient characteristics of FOLFIRI or FOLFOX medication regimen selection and the effects of each regimen on patients' health outcomes in a real-world setting. Three thousand seven hundred and twenty-five patients were retrieved and 610 of them were eventually included in this study based on the inclusion and exclusion criteria. The percentages of the TNM stage, cetuximab, bevacizumab, and tumor metastases between the FOLFIRI and FOLFOX groups were different (P < 0.001). In the multivariate Cox proportional hazards model, a significantly higher non-convalescent incidence of the FOLFOX group was found as compared with the FOLFIRI group (HR = 2.211, 95% CI = 1.257–3.888, P = 0.006). In conclusion, the TNM stage, whether combined with cetuximab or bevacizumab, and whether there was tumor metastasis presented as the key factors affecting medication selection between the FOLFIRI and FOLFOX regimens. The FOLFIRI regimen exhibited better effects on patients' long-term health outcomes than did the FOLFOX regimen. This study was registered on the World Health Organization International Clinical Trials Registry Platform (ChiCTR2000029201).Trial registration: ChiCTR2000029201.
Highlights
Cancer is a globally recognized major public health problem and one of the common diseases that seriously threaten human health [1]
In the latest National Comprehensive Cancer Network (NCCN) guidelines on the first-line palliative chemotherapy for advanced colorectal cancer, the recommended grades in fluorouracil combined with irinotecan (FOLFIRI) or fluorouracil combined with oxaliplatin are class I recommendations, meaning that the clinical use of both options is preferred [8]
The MAVERICC Study compared the efficacy of FOLFIRI plus bevacizumab (FOLFIRI-BV) with mFOLFOX6 plus bevacizumab in metastatic colorectal cancer patients, and the results showed that these two treatment groups had a similar progression-free survival (PFS) [hazard ratio (HR) = 0.79, 95% CI = 0.61–1.01, P = 0.06] and overall survival (OS) (HR = 0.76, 95% CI = 0.56–1.04, P = 0.09) [9]
Summary
Cancer is a globally recognized major public health problem and one of the common diseases that seriously threaten human health [1]. The current treatment options of cancer, such as comprehensive treatment, radiotherapy, chemotherapy, targeted therapy, immunotherapy, and other methods, have greatly improved the survival of cancer patients [2, 3]. Among these treatment methods, chemotherapy plays a very important role because of its universality and effectiveness [4]. Fluorouracil has often been used in combination with oxaliplatin or irinotecan for patients with solid tumors like colorectal cancer and gastric cancer [7]. Irinotecan, a semi-synthetic derivative of camptothecin, has adverse reactions such as acute cholinergic syndrome [13]
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