FOLFOXIRI Versus Doublet Regimens in Right-Sided Metastatic Colorectal Cancer: Focus on Subsequent Therapies and Impact on Overall Survival.
INTRODUCTION
It has been determined that right-sided metastatic colorectal cancer (mCRC) has a worse prognosis for overall survival (OS). Currently, there is no consensus on the best systemic regimen for treatment-naive right-sided tumors. We compared the impact of subsequent therapies on OS of patients treated with FOLFOXIRI (leucovorin, 5-fluorouracil, oxaliplatin, irinotecan) versus doublet regimens.


PATIENTS AND METHODS
Data of patients with treatment-naive right-sided mCRC who received FOLFOXIRI or doublet regimens between January 2001 to December 2018 were retrospectively analyzed. OS was compared between the two groups, and prognostic factors were assessed by multivariate analysis.


RESULTS
A total of 196 patients were selected; 33 patients received FOLFOXIRI and 163 patients doublet therapy. Median follow-up was 82.3 months. The FOLFOXIRI cohort received fewer subsequent lines of therapies (61% vs. 78%, P = .043). The greater the number of subsequent lines of therapy, the lower the risk of death (hazard ratio [95% confidence interval] 0.67 [0.46-0.99], 0.62 [0.45-0.86], and 0.56 [0.39-0.81] for > 1, > 2, and > 3 lines, respectively). By multivariate analysis, metastasectomy and bevacizumab with subsequent lines of therapy were the variables with greatest positive impact on OS (respectively, hazard ratio [95% confidence interval] 0.54 [0.38-0.78] and 0.61 [0.44-0.84]).


CONCLUSION
Patients with treatment-naive right-sided mCRC who received front-line FOLFOXIRI had a lower number of subsequent therapies than patients who received doublet regimens. Our findings highlight the relevance of the continuum of care in mCRC, regardless of the first-line regimen, and the importance of careful selection of patients for the FOLFOXIRI regimen.
['Jácome|Alexandre A|AA|', 'Kee|Bryan|B|', 'Fogelman|David|D|', 'Dasari|Arvind|A|', 'Shureiqi|Imad|I|', 'Raghav|Kanwal|K|', 'Morris|Van|V|', 'Johnson|Benny|B|', 'Overman|Michael|M|', 'Wolff|Robert|R|', 'Kopetz|Scott|S|', 'Rogers|Jane|J|', 'Ahmed|Shahab U|SU|', 'Mehdizadeh|Amir|A|', 'Rothschild|Nicole|N|', 'Eng|Cathy|C|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000971:Antineoplastic Combined Chemotherapy Protocols D000068258:Bevacizumab D002166:Camptothecin D000066491:Clinical Decision-Making D015179:Colorectal Neoplasms D004334:Drug Administration Schedule D005260:Female D005472:Fluorouracil D005500:Follow-Up Studies D006801:Humans D002955:Leucovorin D008297:Male D059146:Metastasectomy D008875:Middle Aged D009944:Organoplatinum Compounds D018579:Patient Selection D011379:Prognosis D000077982:Progression-Free Survival D012189:Retrospective Studies D015996:Survival Rate D055815:Young Adult
Prognosis Metastasectomy Colorectal neoplasms Drug therapy Tumor sidedness