mFOLFOX-4 followed by mFOLFIRI or the Reverse Sequence in Metastatic Gastric Cancer

Abstract:	2665
Congress:	ESMO 2010
Type:	Abstract
Topic:	Gastrointestinal tumors
Authors:	S. Lee, H.-C. Kwon, S.Y. Oh, S.-H. Kim, K. Kwon, J.H. Lee, H.-J. Kim; Busan/Korea, Republic of

• Body

  Background

  Both FOLFOX and FOLFIRI regimen have been evaluated in a number of phase II studies in the first- and second-line treatment of metastatic gastric cancer. This study investigated two sequences: low dose leucovorin (ldLV), 5-FU, and oxaliplatin (modified FOLFOX-4) followed by ldLV, 5-FU, and irinotecan (modifided FOLFIRI; arm A), and mFOLFIRI folllowed by mFOLFOX (arm B).

  Patients and Methods

  Previously untreated patients with metastatic or recurrent gastric cancer were received leucovorin 20 mg/m2 iv bolus followed by a 5-FU iv bolus 400mg/m2 and 22-hour continuous infusion 600mg/m2 on day 1 and 2, either with oxaliplatin 85mg/m2 or with irinotecan 150mg/m2 on day 1 every 2 weeks. At progression, oxaliplatin was replaced by irinotecan, or irinotecan by oxaliplatin.

  Results

  Median survival was 11.3 months in 40 patients treated by mFOLFOX4 then mFOLFIRI versus 9.7 months in 37 patients treated by mFOLFIRI then mFOLFOX-4 (p = 0.143). Median second time to progression (TTP) was 6.4 months in arm A versus 5.7 months in arm B (p = 0.015). In first-line therapy, mFOLFOX-4 achieved 37.5% response rate (RR) and 2.9 months median TTP, versus mFOLFIRI which achieved 27% RR and 2.9 months TTP (p = 0.154). Second-line mFOLFOX-4 achieved 10.8% RR and 1.7 months TTP, versus mFOLFIRI which achieved 15.4% RR and 2.2 months TTP (p = 0.036).

  Conclusion

  Both sequences achieved a similar efficacy in overall survival, but mFOLFOX-4 followed by mFOLFIRI was slightly preferred in time to progression.