Selected Treatment Schedules: Adenocarcinoma, Rectum, Squamous Cell carcinoma, Anus

Selected Treatment Schedules

2dd, twice daily; AUC, area under the concentration–time curve; BMI, body mass index; FU, fluorouracil; HER2, human Epidermal growth factor receptor 2; FOLFIRI, folinic acid, fluorouracil and irinotecan; 5-FU, 5-fluorouracil.

Adenocarcinoma, Rectum

(Neo)adjuvant Palliative
Chemoradiation: capecitabine 2dd 825 mg/m2 continuously (with radiotherapy Monday–Friday)[20] 3-weekly capecitabine 2dd 1250 mg/m2 d1-14[21]
--- CapOx: 3-weekly oxaliplatin 130 mg/m2 (d1), capecitabine 2dd 1000 mg/m2 d1-14
--- FOLFOX4: oxaliplatin 85 mg/m2 d1, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 600 mg/m2/22 h, d1, 2 q14[9]
--- mFOLFOX6: oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, followed by 5-FU 1200 mg/m2/48 h, d q14[10]
--- FOLFIRI: irinotecan 180 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 2400 mg/m2/48 h[12]
--- 3-weekly irinotecan 350 mg/m2 or 600 mg flat dose if BMI ≤30 kg/m2[16]
--- FOLFOXIRI: oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, irinotecan 165 mg/m2, 5-FU 3200 mg/m2/48 h[22]
--- FOLFIRI + aflibercept 4 mg/kg[23]
--- 2-weekly panitumumab 6 mg/kg[17]
--- 3-weekly cetuximab 250 mg/m2 (400 mg loading dose)[18]
--- Regorafenib 160 mg continuously[19]

References

9. Colucci G, Gebbia V, Paoletti G, et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 2005; 23:4866–4875.

10. Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004; 22:229–237.

12. Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 2005; 352:2696–2704.

16. Cunningham D, Pyrhönen S, James RD, et al. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 1998; 352:1413–1438.

17. Van Cutsem E, Peeters M, Siena S, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 2007; 25:1658–1664.

18. Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004; 351:337–345.

19. Grothey A, Van Cutsem E, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381:303–312.

20. Hofheinz RD, Wenz F, Post S, et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 2012; 13:579–588.

21. Ho C, Ng K, O’Reilly S, Gill S. Outcomes in elderly patients with advanced colorectal cancer treated with capecitabine: a population-based analysis. Clin Colorectal Cancer 2005; 5:279–282.

22. Falcone A, Ricci S, Brunetti I, et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 2007; 25:1670–1676.

23. Peeters M, Price TJ, Cervantes A, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol 2010; 28:4706–4713.

 

Squamous Cell Carcinoma, Anus

(Neo)adjuvant Palliative
Chemoradiation: mitomycin 12 mg/m2 d1, FU 1000 mg/m2/24 h for 4 days in first and final radiation week[24] 3-weekly cisplatin (carboplatin) 80 mg/m2 (AUC 5), 
FU 1000 mg/m2/24 h d1-5

References

24. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996; 348:1049–1054.

Last update: 08 July 2016