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FOLFOX regimen in resistant metastatic colon cancer

Treatment with metastatic colon cancer with 5-FU often ends up with treatment resistance. In order to regain tumor response in these patients a new regimen (FOLFOX) adding oxaliplatin and leucovorin to 5-FU was developed. In previous clinical trials, a reponse rate of 20 to 46% has been achieved with this treatment schedule.

A new study from France presented at the ASCO-Meeting was undertaken in order to compare different dosages of oxaliplatin and leucovorin in combination with 5-FU. FOLFOX2 consisted of oxaliplatin (100mg/m² day 1), leucovorin (500mg/m²) followed by 5-FU (1,5-2g/m²/22 h) each at day 1 and 2 twice per month. FOLFOX3 used the same schedule as FOLFOX2 with the exception of a decreased oxaliplatin dose (85mg/m²). The FOLFOX6 group received oxaliplatin (100mg/m²), leucovorin (400mg/m²) followed by a bolus of 5-FU and a 46-hour infusion of 2,4-3mg/m².

126 patients were included in the study and analysed provided that they had at least received 4 cycles. Based on the oxaliplatin dose two groups were established for the purpose of evaluation. Patients having been treated with more than 85mg/m² oxaliplatin showed a response rate of 39% and a progression free survival rate of 52% at 6 months. The corresponding figures for the lower dosage group (< 85mg/m²) were 19% and 36% respectively, yielding a significant difference. A trend favouring the higher dose of oxaliplatin was also seen when looking at survival rate at 1 year (69% versus 44%) and median survival (67 weeks versus 44 weeks).