FOLFOXIRI for First-Line Treatment of Unresectable Colorectal Cancer with Liver Metastases in a Resource-Limited Setting.

IF 1.6 Q4 ONCOLOGY Journal of Gastrointestinal Cancer Pub Date : 2024-10-31 DOI:10.1007/s12029-024-01133-4

Vuong Dinh Thy Hao, Phan Minh Tri, Doan Tien My, Le Tuan Anh, Lam Viet Trung, Nguyen Hoang Bac, Nguyen Lam Vuong

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Abstract

Purpose: FOLFOXIRI is a standard treatment for unresectable colorectal cancer (CRC) liver metastases. However, limited data exists on its safety and effectiveness in low-to-middle-income countries (LMICs). This prospective study addresses this gap in a Vietnamese LMIC setting.

Methods: We enrolled 92 patients with unresectable CRC liver metastases between 2022 and 2023. All patients received FOLFOXIRI every 2 weeks, with routine G-CSF prophylaxis to prevent neutropenia. A multidisciplinary team (MDT) assessed diagnoses and treatment responses. Outcomes were R0/R1 resection rate, progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), adverse events (AEs), and recurrence-free survival (RFS) for surgical patients.

Results: The median patient age was 56 years, with a male predominance (70.7%). The primary tumors were located in the left colon (42.4%), rectum (37%), and right colon (20.7%). Thirty-two patients (34.8%) experienced severe (grade 3 or higher) AEs, with thrombocytopenia (13.1%) and anemia (9.8%) being the most frequent. Most patients (72/87, 82.9%) achieved a partial response. The ORR and DCR were 85.1% and 95.4%, respectively. Fifty-seven patients (62%) achieved resectability, and 54 (58.7%) underwent radical surgery. The R0/R1 resection rate was 88.9%. The median PFS and OS for all patients were 13 and 22 months, respectively. The median RFS of surgical patients was 14 months.

Conclusions: FOLFOXIRI improves the response rates, R0/R1 resection rates, and survivals for patients with CRC liver metastases. Future research is necessary to improve the prognosis of patients while minimizing toxicities.

Trial registration: NCT05362825 dated 5 May 2022.

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在资源有限的情况下，FOLFOXIRI 用于不可切除的结直肠癌肝转移的一线治疗。

治疗目的FOLFOXIRI 是治疗无法切除的结直肠癌（CRC）肝转移的标准疗法。然而，有关其在中低收入国家（LMICs）安全性和有效性的数据十分有限。本前瞻性研究针对越南中低收入国家的这一空白进行了研究：我们在 2022 年至 2023 年间招募了 92 例无法切除的 CRC 肝转移患者。所有患者均接受每两周一次的 FOLFOXIRI 治疗，并常规使用 G-CSF 预防性治疗以防止中性粒细胞减少症。多学科团队（MDT）对诊断和治疗反应进行评估。结果包括手术患者的R0/R1切除率、无进展生存期（PFS）、总生存期（OS）、客观反应率（ORR）、疾病控制率（DCR）、不良事件（AEs）和无复发生存期（RFS）：患者年龄中位数为56岁，男性居多（70.7%）。原发肿瘤位于左侧结肠（42.4%）、直肠（37%）和右侧结肠（20.7%）。32名患者（34.8%）出现了严重的（3级或以上）不良反应，其中血小板减少（13.1%）和贫血（9.8%）最为常见。大多数患者（72/87，82.9%）获得了部分应答。ORR和DCR分别为85.1%和95.4%。57名患者（62%）实现了切除，54名患者（58.7%）接受了根治手术。R0/R1切除率为88.9%。所有患者的中位 PFS 和 OS 分别为 13 个月和 22 个月。手术患者的中位RFS为14个月：结论：FOLFOXIRI提高了CRC肝转移患者的反应率、R0/R1切除率和生存率。未来的研究有必要在改善患者预后的同时将毒性降至最低：试验注册：NCT05362825，日期为 2022 年 5 月 5 日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.