The Pharmaceutical Journal
Vol 277 No 7422 p442
14 October 2006

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Oral capecitabine-based regimen is as effective as infused 5-FU therapy in advanced colorectal cancer

Chemotherapy based on oral capecitabine is as effective in terms of progression-free survival as the current standard treatment (infused 5-fluorouracil/leucovorin plus oxaliplatin) for advanced colorectal cancer and requires far less infusion time, a study has shown.

The international study, presented earlier this month at the European Society for Medical Oncology congress in Istanbul, initially randomised 2,034 patients to two first-line chemotherapy regimens — XELOX (capecitabine plus oxaliplatin) or FOLFOX (intravenous bolus and infused 5-fluorouracil plus oxaliplatin). Bevacizumab was added to one arm of patients on each chemotherapy regimen, after its ability to improve survival was demonstrated in data published in 2003.

Results show that the two chemotherapy regimens are similar in terms of progression-free survival (hazard ratio 1.05). Adding bevacizumab to chemotherapy (FOLFOX or XELOX) improved progression-free survival by 17 per cent compared with chemotherapy alone (hazard ratio 0.83).

Jim Cassidy, Cancer Research UK professor of oncology, University of Glasgow, and lead investigator for the study, explained that patients on the XELOX combination require only four hours of infusion over a typical six-week treatment cycle compared with 144 hours for FOLFOX, with fewer hospital or clinic visits. “In addition, the study confirms that by adding bevacizumab to chemotherapy we can improve progression-free survival times even further,” he said.

Steve Williamson, lead pharmacist for the Northern Cancer Network and Northumbria Trust, said: “Confirmation of the ability to substitute capecitabine for infused 5-fluorouracil and adopt the XELOX regimen has important consequences for pharmacy … allowing pharmacy departments to refocus the staff time saved in preparing 5-FU infusions into providing direct clinical support to patients. XELOX is set to become a key regimen in colorectal cancer — pharmacists must ensure they are providing supportive care to oral chemotherapy patients.”