Combination Therapy May Be Better for Colon Cancer

Two reports compared combination versus sequential treatment with cytotoxic agents

FRIDAY, July 13 (HealthDay News) -- First-line combination therapy with cytotoxic drugs may be better for treatment of most patients with advanced colon cancer but the optimal strategy should be tailored for each patient, according to two reports in the July 14 issue of The Lancet.

Cornelis Punt, M.D., from the University Nijmegen Medical Centre in the Netherlands, and the capecitabine, irinotecan and oxaliplatin in advanced colorectal cancer (CAIRO) investigators found that sequential treatment with capecitabine and irinotecan was no better than first-line combination treatment with regard to overall survival. The study included 820 patients with advanced colon cancer.

In the second study, called MRC FOCUS, Matthew Seymour, M.D., of Cookridge Hospital in Leeds, United Kingdom, found that patients with advanced or metastatic colorectal cancer receiving fluorouracil plus irinotecan had a significant improvement in survival of almost three months compared with sequential treatment. This study included 2,135 patients randomly assigned to sequential treatment or various combination regimens.

"Clinically validated prognostic and predictive factors, such as genomic tests, are needed to define in which patients more intensive therapy is worthwhile," write Hans-Joachim Schmoll, M.D., Ph.D., of Martin-Luther-University in Halle, Germany, and a colleague, in an accompanying editorial. "Until then, to maximize the potential benefit for each patient, an approach based on prognosis and disease presentation with initial combination chemotherapy for most patients, reserving single-agent fluorouracil for patients with less aggressive or never-resectable disease, should be the standard of care for first-line treatment of metastatic colorectal cancer."

Punt has received research grants and honoraria from Sanofi-Aventis, Roche and Pfizer.

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