The safety and efficacy of FOLFIRI as second-line chemotherapy for metastatic colorectal cancer patients ≥ 75 years was retrospectively evaluated. We analyzed 106 patients, who received FOLFIRI or a combination of FOLFIRI and bevacizumab following oxaliplatin-based first-line chemotherapy. The clinical characteristics and outcome in elderly patients ≥75 years(elderly[EP]group; n=18)were compared with those in patients aged<75 years(control group; n=88). The number of patients treated by a combination of FOLFIRI and bevacizumab in the EP group was lower than that in the control group (27.8% vs 55.7%; p=0.03). The comparison revealed no significant differences in response rate, progression-free survival, overall survival, and the frequency of overall adverse events after the start of second-line chemotherapy, although the frequency of anemia(Bgrade 3, p=0.07)and alopecia(grade 1/2, p=0.054)tended to be higher in the EP group than in the control group. Although this study retrospectively analyzed a limited number of patients, our results indicate that the safety and efficacy of FOLFIRI as second-line chemotherapy for metastatic colorectal cancer are almost equal in patients ≥ 75 years and those aged<75 years.

Several oxaliplatin-specific scales have been proposed in clinical practice to evaluate oxaliplatin-related neurotoxicity. We investigated whether there might be a discrepancy between the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) and the Neurotoxicity Criteria of Debiopharm (DEB-NTC), the commonly used oxaliplatin-specific scales, in the evaluation of peripheral neurotoxicity.

PURPOSEThe use of opioid analgesics and nonopioid medicines for the treatment of various symptoms in regional cancer centers is considered to be an index of the effectiveness of the structural plan for palliative care in such institutions. The present study aimed to establish an accurate representation of the actual use of opioid analgesics for palliative care in regional cancer centers.METHODSIn November 2007, a questionnaire regarding the use of medications for palliative care was conducted in 288 regional cancer centers in Japan. Valid responses were received from 264 institutions (response rate, 91.4%).RESULTSAll regional cancer centers reported using both opioid analgesics and nonopioid medicines. However, regarding opioid analgesics, the use of each standard strength ranged from 7% to 100%. The total amount of opioid analgesics used was 1739.6 +/- 1216.5 g (mean +/- SD). Factors found to be significantly related to the total amount of opioid analgesics used in an institution were the number of opioid analgesic medicines in use (p = 0.008), the number of inpatients with cancer (p < 0.001), the number of deaths among patients with cancer (p < 0.001), and the number of beds (p < 0.001).DISCUSSIONIncrease in the amount of opioid analgesics might improve the quality of palliative care at regional cancer centers.

BACKGROUND:Whether the administration of calcium (Ca) and magnesium (Mg) can reduce oxaliplatin-related neurotoxicity remains controversial. In addition, little is known about the effects of Ca/Mg on the blood level of platinum or objective tumor progression.PATIENTS AND METHODS:Patients receiving modified FOLFOX6 for metastatic colorectal cancer were double-blinded and randomized to receive additional treatment with Ca/Mg or placebo before and after the administration of oxaliplatin. The plasma and ultrafiltrable concentrations of platinum during the first and fifth cycles of treatment were determined using inductively coupled plasma spectrometry.RESULTS:Patients were randomized to receive Ca/Mg (Ca/Mg group, n = 17) or placebo (placebo group, n = 16) before and after the administration of oxaliplatin (85 mg/m(2)). The incidence of neurotoxicity after six cycles was not significantly different between the two groups. Blood concentrations of platinum at each time and the area under the curve were also not significantly different between the two groups. Furthermore, the response rate (RR) and disease control rate (DCR) did not differ significantly between the two groups (Ca/Mg group: RR 36%, DCR 73%. Placebo group: RR 40%, DCR 70%, P > 0.99). The median progression-free survival time was 9.2 months in the Ca/Mg group and 8.1 months in the control group; these survival times were not significantly different (P = 0.56).CONCLUSION:These data are insufficient to conclude with any certainty that the administration of Ca/Mg is not neuroprotective; however, the administration of Ca/Mg may not have any influence on antitumor activity and the blood concentration profile of platinum in patients receiving oxaliplatin-based chemotherapy.

PURPOSE:This retrospective study was performed to evaluate a survival benefit of the full administration of 5-fluorouracil (5-FU), irinotecan (CPT-11), and oxaliplatin (L-OHP) to patients with unresectable or recurrent colorectal cancer.PATIENTS AND METHODS:The subjects are 145 patients with unresectable or recurrent colorectal cancer who were given CPT-11 and/or L-OHP in addition to 5-FU. The overall survival times of these patients were evaluated.RESULTS:The median survival time (MST) was significantly longer in patients treated with three drugs (n=72) than patients treated with two drugs (n =73) (31.6 months versus 18.4 months, p<0.01). When analysis was restricted to patients treated with three drugs, there was no significant difference in MST between patients who were given L-OHP followed by CPT-11 (n=18) and those treated with these two drugs in reverse order (n=54) (p=0.67).CONCLUSIONS:Compared with the use of 5-FU in combination with CPT-11 or L-OHP, a full administration of three drugs may have a more beneficial impact on patients' survival and irrespective of the order of administering CPT-11/L-OHP.

BACKGROUND:Gornet et al.(2002) reported that patients who received chemotherapy containing oxaliplatin for metastatic colorectal cancer experienced exacerbation of neurotoxicity after surgical resection and suggested that the possible mechanism behind exacerbation of neurotoxicity was perioperative transfer of accumulated platinum from the red blood cells into the plasma. However, no further reports about this issue have been published.PATIENTS AND METHODS:We investigated changes of neurotoxicity after resection in three patients who received modified FOLFOX6 therapy prior to surgery. In addition, changes of the total plasma, ultrafiltrate, and erythrocyte platinum levels were determined by inductively coupled plasma mass spectrometry.RESULTS:Exacerbation of neurotoxicity was not seen in any of the patients postoperatively. The platinum concentrations of all samples did not change significantly from before surgery to 4, 24, and 48 hours postoperatively.CONCLUSION:Further assessment of patients is needed to draw a definite conclusion, but our preliminary data suggest that the risk of neurotoxicity exacerbation due to perioperative changes of the platinum pool is low.

Chemotherapy is potentially hazardous for patients with liver dysfunction. Although FOLFOX regimen is one of the standard chemotherapies for nonresectable liver metastases of colorectal cancer, the safety of this regimen has not been established yet in patients with obstructive jaundice associated with multiple liver metastases. We report a case of nonresectable liver metastases of rectal cancer treated by modified FOLFOX6 regimen after percutaneous transhepatic biliary drainage for obstructive jaundice, which was caused by hepatic lymph-node metastasis. Five days after giving a birth, a 32-year-old woman underwent Hartmann's procedure for perforation of rectal cancer associated with multiple liver metastases. She was admitted again to receive chemotherapy 35 days after surgery, but the level of total bilirubin was elevated (3.9 mg/dL). Since the total bilirubin level was not rapidly decreased after PTBD, the modified FOLFOX6 regimen was started with a 70% dose. After an introduction of mFOLFOX6 treatment, a biliary-stenting was successfully performed, and the mFOLFOX6 continued with a full dose starting from the 5th cycle. Although the therapeutic efficacy after an additional 8-cycle was classified as stable disease (SD), she did not show any sign of adverse effects except for grade 1 neurotoxicity.

PURPOSE This retrospective study was performed to clarify the efficacy and safety of FOLFOX regimen in aged patients with nonresectable colorectal cancer. PATIENTS AND METHODS We had 92 patients with nonresectable colorectal cancer between December 2005 and March 2008. The rate of introducing modified FOLFOX6 (mFOLFOX6) regimen was compared among the patients aged 75 years or older (n = 22, aged group) and those aged 74 years or younger (n = 55, younger group). In addition, relative dose intensity (RDI), therapeutic efficacy, and adverse events in the patients who were given the regimen, we compared between the groups. RESULTS The rate of introducing the regimen was significantly lower in the aged group (36%, n = 8) than in the younger group (79%, n = 55) (p<0.01). The RDI tended to be lower in the aged group (68.0% versus 79.9%, p=0.10). There were no significant differences in the response rate, disease-control rate, progression-free survival, and overall survival between the groups. The rate of adverse events ( > or = grade 3) was not different between the groups ( 50% versus 51%). CONCLUSION Similar to younger patients the mFOLFOX6 regimen is feasible, safe and effective in the selected aged patients, although the dose reduction may be needed for such patients.