Cancer Treatment Today » Chemotherapy http://cancertreatmenttoday.org Knowledge is Power Thu, 26 Mar 2026 23:39:25 +0000 en-US hourly 1 Weekly 5 FU http://cancertreatmenttoday.org/weekly-5-fu/ http://cancertreatmenttoday.org/weekly-5-fu/#comments Thu, 21 Feb 2013 03:19:15 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=10721 Fluoropyrimidine (5-fluorouracil [5-FU] is the oldest chemotherapy drug for colon cancer and it is usually given with leucovorin [LV]. , It has a long history of its use for colorectal metastatic cancer and support from many older papers.

Unfortunately, the issue ofweekly versus every three weeks schedule for 5FU.leukovorin has not been resolved, and with the appearance of many new drugs, has receded into the past and is no longer of actual importance to a significant number of patients.  Older evidence from phase II trials suggests that weekly 5-fluorouracil and leucovorin have lower toxicity.

The FDA has not weigned in on the schedule. The indication states that Fluorouracil is effective in the palliative management of carcinoma of the colon, rectum, breast, stomach and pancreas.

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]]> http://cancertreatmenttoday.org/weekly-5-fu/feed/ 0 Xeloda and irinotecan for second or later lines in colorectal cancer http://cancertreatmenttoday.org/xeloda-and-irinotecan-for-second-or-later-lines-in-colorectal-cancer/ http://cancertreatmenttoday.org/xeloda-and-irinotecan-for-second-or-later-lines-in-colorectal-cancer/#comments Sun, 23 Sep 2012 17:53:29 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=9271 The issue that we will discuss is Xeliri (Xeloda and irinotecan) in second or later line of therapy. It is a tempting regimen because Xeldoa is an generally effective drug for colorectal cancer and it is oral.  We start by pointing out that there are now six different classes of drugs with significant antitumor activity in colon cancer:

Fluoropyrimidine (5-fluorouracil [5-FU] which is usually given with leucovorin [LV], capecitabine, tegafur plus uracil [UFT]). Irinotecan, Oxaliplatin, Cetuximab and panitumumab. The latter two are monoclonal antibodies (MoAbs) directed against the epidermal growth factor receptor (EGFR), and bevacizumab, is a monoclonal antibody targeting vascular endothelial growth factor (VEGF). Zaltrap was recenlty(2012) also approved.

The best way to combine and sequence all of these drugs to optimize treatment is not yet established, although for intial treatment of metasatic colorectal cancer NCCN recommends combinations of 5FU and Lekovorin with oxaliplatin or irinotecan with or without Avastin, CAPEOX, 5FU/Leukovorin, Xeloda and Avastin or Folfoxiri.

For second or third line therapy, single agents are acceptable and NCCN lists irinotecan as a single agent. It also lists combinations, see p. COL-C of the NCCN guideline for colon cancer. NCCN has a complex schema when to give what for second line and also lists irinnotecan or Folfiri with Erbitux, Zaltrap or Vectbix. However, it does not list irinotecan with Xeloda.

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]]> http://cancertreatmenttoday.org/xeloda-and-irinotecan-for-second-or-later-lines-in-colorectal-cancer/feed/ 0 Chemo Options for Later Lines of Therapy for Metastatic Colon Cancer http://cancertreatmenttoday.org/chemo-options-for-later-lines-of-therapy-for-metastatic-colon-cancer-2/ http://cancertreatmenttoday.org/chemo-options-for-later-lines-of-therapy-for-metastatic-colon-cancer-2/#comments Thu, 19 Jul 2012 02:55:29 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=3624 There are now five different classes of drugs with significant antitumor activity in colon cancer:

Fluoropyrimidine(5-fluorouracil [5-FU] which is usually given with leucovorin [LV], capecitabine, tegafur plus uracil [UFT]), Irinotecan, Oxaliplatin, Cetuximab and panitumumab (Vectbix). The latter two are monoclonal antibodies (MoAbs) directed against the epidermal growth factor receptor (EGFR), and bevacizumab, is a monoclonal antibody targeting vascular endothelial growth factor (VEGF).

The best way to combine and sequence all of these drugs to optimize treatment is not yet established, although for initial treatment of metastatic colorectal cancer NCCN recommends combinations of 5FU and Lekovorin with oxaliplatin or irinotecan with or without Avastin, CAPEOX, 5FU/Leukovorin, Xeloda and Avastin or Folfoxiri.

For second or third line therapy, single agents are acceptable but NCCN lists only irinotecan as a single agent. It also lists combinations of these drugs, Erbitux and Vectbix(for wild type KRA patients), see p. COL-C of the NCCN guideline for colon cancer. NCCN has a complex schema when to give what for second line and also lists Erbitux and Vectbix. However, capecitabine is also FDA approved as a single agent. NCCN does not list 5FU/Leikovorin but it can also be considered appropriate given the long history of its use for colorectal metastatic cancer and support form many older papers.

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