Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Tokyo, Japan.
Jpn J Clin Oncol. 2010 Jul;40(7):634-8. doi: 10.1093/jjco/hyq029.
Recently, significant progress in treatment of metastatic colorectal cancer has been achieved. Either FOLFIRI (fluorouracil, leucovorin and irinotecan) or modified FOLFOX6 (fluorouracil, leucovorin and oxaliplatin, oxaliplatin dose 85 mg/m(2)) is selected as first-line therapy in clinical practice in Japan. However, economic burden of colorectal cancer is considerable.
Analysis was made for all patients who were treated with FOLFIRI or modified FOLFOX6 for metastatic colorectal cancer. Regimen of FOLFIRI was compared with modified FOLFOX6 under consideration from clinical and economic standpoints. Progression free survival, response, toxicity and cancer care cost in patients with metastatic colorectal cancer was analyzed. Direct costs based on the fee schedule of the Japanese national health insurance were calculated.
Median progression free survival was 7.7 months for FOLFIRI versus 8.4 months for modified FOLFOX6 (P = 0.48). Overall cost for first four cycles was yen756 284 for FOLFIRI and yen1 081 162 for modified FOLFOX6 (P < 0.0001). All grade alopecia was significantly more frequent with FOLFIRI than with modified FOLFOX6 (P = 0.04). All grade neuropathy was more observed with modified FOLFOX6 than FOLFIRI (P = 0.0002).
FOLFIRI is inexpensive in the initial stage of treatment which a number of patients can receive chemotherapy than modified FOLFOX6 as first-line therapy for metastatic colorectal cancer in Japanese national insurance system.
转移性结直肠癌的治疗最近取得了显著进展。氟尿嘧啶、亚叶酸钙和伊立替康（FOLFIRI）或改良 FOLFOX6（氟尿嘧啶、亚叶酸钙和奥沙利铂，奥沙利铂剂量 85mg/m²）在日本临床实践中均被选为一线治疗药物。然而，结直肠癌的经济负担相当大。
对所有接受 FOLFIRI 或改良 FOLFOX6 治疗转移性结直肠癌的患者进行了分析。从临床和经济角度考虑，对 FOLFIRI 方案与改良 FOLFOX6 方案进行了比较。分析转移性结直肠癌患者的无进展生存期、反应、毒性和癌症护理成本。根据日本国民健康保险的费用表计算直接成本。
FOLFIRI 的中位无进展生存期为 7.7 个月，改良 FOLFOX6 为 8.4 个月（P=0.48）。FOLFIRI 的前四个周期的总费用为 756284 日元，改良 FOLFOX6 为 1081162 日元（P<0.0001）。FOLFIRI 组的全级别脱发发生率明显高于改良 FOLFOX6 组（P=0.04）。改良 FOLFOX6 组的全级别神经病变发生率高于 FOLFIRI 组（P=0.0002）。
在日本国民健康保险体系中，FOLFIRI 作为转移性结直肠癌的一线治疗药物，其初始治疗阶段费用较低，可使更多患者接受化疗。
