Abstract
Aims and Background: Irinotecan is a standard option for relapsed/refractory advanced colo- rectal cancer. Combination with raltitrexed and irinotecan at lower than MTD doses should preserve disease stabilisation while decreasing toxicity. Patients and Methods: From January 2004 to April 2009, we analyzed, retrospectively, our data on irinotecan + raltitrexed, fixed doses, as a second-line chemotherapy in elderly pa- tients (>70 years) with advanced colorectal can- cer after failure of oxaliplatin based chemothera- py twenty-three patients were evaluated. Iri- notecan 350 mg + raltitrexed 2.6 mg were given every 3 weeks. Tumo r measurements were ob- tained after every third course of therapy. Toxic- ity was assessed weekly using the National Cancer Institute Common Toxicity Criteria, ver- sion 2. Results: The median number of treatment courses received per patient was 4 (range, 1 - 8). All pa-tients were assessable for toxicity and 21 for response. The most frequently observed severetoxicities were diarrhea (grade 2, 13%) No cases of significant neutropenia occurred. Ob- jective partial responses were observed in 3 pa- tients (13%). An additional 10 patients (43%) had stable disease as their best response. To date, 12 patients have progressed with a median time- to-progression of 4.3 months and a median sur- vival of 8.3 months. Conclusions: A three weekly irinotecan + raltitrexed administration can indu- ce tumor control in elderly patients with advanc- ed colorectalcancer that has progressed during or shortly after oxaliplatin-based chemotherapy. The diarrhea by irinotecan, seems mitigated by coad-ministration of a smaller dose of raltitrexed
Highlights
Irinotecan (CPT-11), a DNA topoisomerase I inhibitor, has demonstrated antitumor activity as a single agent in the second-line treatment of advanced colorectal cancer (ACC) [1,2]
By lowering the dose to the lowest one active for both drugs, we hoped to avoid the neutropenia associated with three weekly irinotecan, whilst maintaining an easy outpatient regimen conceived for elderly patients risk
From January 2004 to April 2011, we retrospectively collected our data on elderly patients with ACC responding to defined selection criteria and treated with irinotecan + raltitexed as second-line treatment following 5-FU/oxaliplatin-based therapy
Summary
Irinotecan (CPT-11), a DNA topoisomerase I inhibitor, has demonstrated antitumor activity as a single agent in the second-line treatment of advanced colorectal cancer (ACC) [1,2]. By lowering the dose to the lowest one active for both drugs, we hoped to avoid the neutropenia associated with three weekly irinotecan, whilst maintaining an easy outpatient regimen conceived for elderly patients risk. Due to the physiological reduction of functional organ reserve and the presence of comorbid conditions, elderly patients are often excluded from clinical trials. These subjects frequently suffer from tumor-related symptoms and need some kind of palliative treatment. From January 2004 to April 2011, we retrospectively collected our data on elderly patients with ACC responding to defined selection criteria and treated with irinotecan + raltitexed as second-line treatment following 5-FU/oxaliplatin-based therapy
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