Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Clin Colorectal Cancer. 2012 Dec;11(4):229-37. doi: 10.1016/j.clcc.2012.05.001. Epub 2012 Jun 12.
A major problem concerning the addition of more drugs in a chemotherapy combination is designing a proper schedule assuring the balance between dose intensity of each drug, efficacy of the combination, and tolerability lessening the burden of drug toxicity. We evaluated triplet chemotherapy-based intensive regimens proposed as first-line treatment in patients with metastatic colorectal cancer. Using a FOLFOXIRI (5-fluorouracil [5-FU], irinotecan, and oxaliplatin) combination regimen, patients with metastatic colorectal cancer now have the possibility of longer survival, but disappointingly, with increased toxicities. Triplet chemotherapy regimen according to 5-fluorouracil, irinotecan /5-fluorouracil, oxaliplatin, characterized by timed flat-infusion 5-FU administration, without leucovorin, obtained efficacy equivalent to other reported similar combination regimens (5-FU, irinotecan, and oxaliplatin), with increased received 5-FU dose intensity and lower grade 3 to 4 neutropenia. To guarantee the proper balance between dose intensities, efficacy, and toxicity, triplet chemotherapy schedules could be further improved by abrogation of folinic acid and bolus 5-FU, a new and easy modality of 5-FU administration, such as timed flat-infusion 5-FU, associated with alternating irinotecan and oxaliplatin; this could favor diffusion of this intensive treatment in clinical practice.
一个主要的问题有关添加更多的药物在化疗联合设计一个适当的时间表确保平衡剂量强度的每一种药物,组合的疗效和耐受性减轻药物毒性的负担。我们评估了三联化疗为基础的强化方案提出一线治疗转移性结直肠癌患者。使用 FOLFOXIRI(5 -氟尿嘧啶[5 - Fu],伊立替康和奥沙利铂)联合方案,转移性结直肠癌患者现在有更长的生存机会,但令人失望的是,增加毒性。三联化疗方案根据 5 - Fu、伊立替康/5 - Fu、奥沙利铂、特点是定时平输注 5 - Fu 管理,没有亚叶酸钙,获得等效疗效其他报道类似的联合方案(5 - Fu、伊立替康和奥沙利铂),增加接受 5 - Fu 剂量强度和较低的 3 级到 4 级中性粒细胞减少症。为了保证剂量强度、疗效和毒性之间的适当平衡,三联化疗方案可以进一步改善废除叶酸和 5 - Fu 推注,5 - Fu 新的和容易的管理模式,如定时平输注 5 - Fu,与交替伊立替康和奥沙利铂;这可能有利于这种密集治疗的扩散在临床实践中。
