1. Concurrent Modulation of 5-Fluorouracil with Methotrexate and L-leucovorin: An Effective and Moderately Toxic Regimen for the Treatment of Advanced Colorectal Carcinoma a Multicenter Phase II Study of the Southern Italy Cooperative Oncology Group
- Author
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Lorusso, Luigi Manzione, Rossana Casaretti, De Lena M, Giacomo Cartenì, De Lucia L, Giuseppe Comella, S. Mancarella, and Pasquale Comella
- Subjects
Adult ,Male ,Oncology ,Antimetabolites, Antineoplastic ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,Leucovorin ,Phases of clinical research ,Disease-Free Survival ,Drug Administration Schedule ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Mucositis ,Humans ,Medicine ,Aged ,Neoplasm Staging ,Performance status ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Regimen ,Methotrexate ,Treatment Outcome ,Italy ,Fluorouracil ,030220 oncology & carcinogenesis ,Female ,Colorectal Neoplasms ,business ,Progressive disease ,medicine.drug - Abstract
Aims and Background Methotrexate (MTX) and leucovorin (LV) can enhance the cytotoxicity of 5-fluorouracil (5FU) by modifying its metabolic pathway inside target cells. Some preclinical studies and clinical trials have suggested that the concurrent or sequential double modulation of 5FU by means of MTX and LV may give a higher activity than single biochemical modulations. The purpose of our phase II study was to assess the activity and toxicity of a biweekly regimen including MTX, levo-LV and 5FU in colorectal cancer patients. Methods From July 1994 to May 1997, 100 consecutive patients affected by advanced or metastatic colorectal carcinoma were given MTX, 750 mg/m2 iv (2-h infusion) on day 1, and levo-LV, 250 mg/m2 iv (2-h infusion) followed by 5FU, 800 mg/m2 iv bolus on day 2, every two weeks. Patients were treated until complete response or progressive disease was documented, or for a maximum of 16 courses. Results Among 97 eligible patients, 5 complete and 25 partial responses were obtained, giving an overall response rate of 31% (95% exact confidence limits, 22-41%). Response rate was significantly higher in patients with a good (ECOG scale 0) than with a poor (ECOG scale 1 or 2) performance status (40% versus 17%, P Conclusions The double biochemical modulation of 5FU by MTX and levo-LV is at least as effective as, and probably more effective than, the single modulation by MTX or by LV. It may therefore represent a therapeutic option for the palliative treatment of patients with advanced colorectal carcinoma.
- Published
- 1999