The optimum use of cytotoxic drugs for advanced colorectal cancer has not been defined.
Dr Miriam Koopman and colleagues from the Netherlands investigated whether combination treatment is better than sequential administration of the same drugs in patients with advanced colorectal cancer.
The team randomly assigned 820 patients with advanced colorectal cancer to 2 groups.
Group 1 included 410 patients that received sequential treatment with either first-line treatment with capecitabine, second-line irinotecan, or third-line capecitabine plus oxaliplatin.
|The median overall survival was 16 months for those in Group 1|
Group 2 included 410 patients that received combination treatments of first-line treatment capecitabine plus irinotecan, and second-line capecitabine plus oxaliplatin.
The primary endpoint was overall survival.
Analyses were done by intention to treat.
The researchers found 17 patients to be ineligible and were excluded from the analysis.
The team noted that 84% of patients died during the study.
The researchers reported that 336 died in the sequential treatment group, and 339 in the combination group.
The team found that the median overall survival was 16 months for those in Group 1, and 17 months for Group 2.
The hazard ratio for Group 1 versus Group 2 was 0.9.
The researchers observed that the frequency of grade 3 to 4 toxicity over all lines of treatment did not differ significantly between the 2 groups.
However, grade 3 hand-foot syndrome occurred more often with patients in Group 1 than in Group 2.
Dr Koopman's team concluded, "Combination treatment does not significantly improve overall survival compared with the sequential use of cytotoxic drugs in advanced colorectal cancer."
"Sequential treatment remains a valid option for patients with advanced colorectal cancer."