الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
The current first-line management of disseminated mCRC involves various active drugs, either in combination or as single agents: 5FU/LV, capecitabine, irinotecan, oxaliplatin, bevacizumab, cetuximab and panitumumab. The association of 5-FU/LV revealed an advantage in terms of RR without any impact on OS. (Rossi et al, 2013)
The doublet chemotherapy FOLFIRI and FOLFOX led to a considerable increase in RR and prolonged OS, and similar RR and PFS times were obtained when these regimens were used as first-line therapy. (Tournigand et al 2004; Colucci et al 2005)
XELOX is comparable to FOLFOX in terms of activity and efficacy, while capecitabine/irinotecan (XELIRI) is burdened by severe gastrointestinal toxicity. (Diaz-Rubio et al, 2007; Kohne et al 2008)
FOLFOXIRI is more effective than FOLFIRI in terms of PFS (9.8 vs 6.9 months; HR 0.70; P= 0.032), although this regimen has to be reserved for patients with appropriate conditions and without relevant comorbidities. (Masi et al, 2010)
The current study analyzed the various chemotherapeutic agents involved in the armamentarium of first line treatment of mCRC in terms of: overall survival, progression-free survival and toxicities; to explore the best options across the continuum of care for patients at Ain Shams University Hospitals.
The results showed that the majority of patients (85.2%) received first-line chemotherapy in the metastatic setting, mostly combination treatment, especially FOLFOX4 (39.5%) and FOLFIRI (22.2%). The median OS was 11 and 8 months for the patients in the FOLFOX and FOLFIRI groups, respectively (P= 0.117). In both arms, the median PFS was 4 and 3.5 months, respectively (P= 0.533) and the ORR in the assessable patients was 12.5% and 11.1%, respectively (P= 0.757). The adverse event profile was favorable overall for both regimens, and grade 3 to 4 toxicities were uncommon in both arms, with more gastrointestinal toxicities in the FOLFIRI arm and more thrombocytopenia in the FOLFOX4 arm, with no statistically significant difference. No deaths that could be related to chemotherapy were reported in either arm.
Currently, conventional first-line therapy of mCRC is based on the association of conventional chemotherapy regimens and biological drugs that include bevacizumab, cetuximab, or panitumumab; in fact, clinical trials have shown that targeted agents increase the efficacy of conventional chemotherapy regimens. (Rossi et al, 2013)
In conclusion, the majority of patients with mCRC cannot be cured, although a subset with liver and/or lung-isolated disease are potentially curable with surgery. However, the diagnosis of mCRC no longer means a rapid downhill course, as many patients live for years with what might be classified as a chronic disease. (Goldberg et al, 2007)