Phase II study of tailored chemotherapy for advanced colorectal cancer with either 5-fluouracil and leucovorin or oxaliplatin and irinotecan based on the expression of thymidylate synthase and dihydropyrimidine dehydrogenase
| Autor: | G. Giaccone, G.J. Peters, C. H. Smorenburg, W. W. Dercksen, P. Noordhuis, A. M. G. H. van Riel, Herbert M. Pinedo, Kees Smid, C. J. van Groeningen |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Organoplatinum Compounds Population Leucovorin Irinotecan Thymidylate synthase Gastroenterology Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Dihydropyrimidine dehydrogenase Humans Prospective Studies RNA Messenger education Dihydrouracil Dehydrogenase (NADP) Aged education.field_of_study Predictive marker biology Reverse Transcriptase Polymerase Chain Reaction business.industry Thymidylate Synthase Hematology Middle Aged Prognosis Chemotherapy regimen Surgery Oxaliplatin Survival Rate Oncology Fluorouracil biology.protein Camptothecin Female Colorectal Neoplasms business medicine.drug |
| Zdroj: | Annals of Oncology. 17:35-42 |
| ISSN: | 0923-7534 |
| Popis: | Background: Thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) are essential enzymes for 5-fluorouracil (5-FU) metabolism. In patients with advanced colorectal cancer (ACRC), retrospective studies have shown that low expression levels of TS and DPD correlated with response to 5-FU. We performed a prospective study in which the choice of first-line chemotherapy with either 5-FU or a non-5-FU containing regimen was based on TS and DPD expression. Patients and methods: Fresh-frozen samples of metastases were obtained from 58 previously untreated patients with ACRC. mRNA expression of TS and DPD was quantified using an RT–PCR assay. Patients with low tumor expression of both TS and DPD received weekly bolus 5-FU/leucovorin (LV) 500 mg/m2 (group A); patients with high TS and/or DPD received 3-weekly oxaliplatin 85 mg/m2 and irinotecan 200 mg/m2 (group B). After progression, cross-over to the alternative regimen was attempted. Results: Of 53 eligible patients, 31 had tumors with both low TS and low DPD, and were treated in group A. A response was observed in 11 patients [35%; 95% confidence interval (CI) 19% to 54%]. Cross-over to second-line oxaliplatin/irinotecan resulted in a partial response in two out of 16 patients (13%; 95% CI 1% to 38%). In group B, four out of 22 patients responded (18%; 95% CI 5% to 40%), while no responses were observed in 12 patients after cross-over to 5-FU/LV (0%; 95% CI 0% to 28%). Conclusions: Prospective selection of 5-FU/LV chemotherapy based on low TS and DPD expression in patients with ACRC did not confirm the high response rates reported in retrospective studies. The procedure of obtaining metastatic tissue and quantitation of enzymes appeared feasible but cumbersome. Before assessing the clinical utility of a predictive marker in a randomized trial, future studies should focus on prospective validation of the assay in a large and well defined population. |
| Databáze: | OpenAIRE |
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