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Efficacy and safety of ramucirumab plus modified FOLFIRI for metastatic colorectal cancer

  • Tomoyasu Yoshihiro
  • Hitoshi Kusaba
  • Akitaka Makiyama
  • Kazuma Kobayashi
  • Masato Uenomachi
  • Mamoru Ito
  • Yasuhiro Doi
  • Kenji Mitsugi
  • Tomomi Aikawa
  • Kotoe Takayoshi
  • Taito Esaki
  • Hozumi Shimokawa
  • Kenji Tsuchihashi
  • Hiroshi Ariyama
  • Koichi Akashi
  • Eishi BabaEmail author
Original Article
  • 86 Downloads

Abstract

Background

Dose modification of chemotherapy for metastatic colorectal cancer (MCRC) is often needed, especially in second-line and later-line treatments due to adverse events of previous treatment and poor patient condition. No study has focused on ramucirumab plus modified dose of FOLFIRI for MCRC, and whether low relative dose intensity (RDI) affects treatment efficacy has not been clarified.

Methods

MCRC patients who received ramucirumab plus FOLFIRI, which consisted of 150 mg/m2 of irinotecan, at six institutions were retrospectively analyzed.

Results

A total of 43 patients were assessed. Median age was 63 years, and 22 patients (51%) were women. Twenty-six patients (60%) were given ramucirumab plus FOLFIRI as second-line therapy, and 17 (40%) as third or later-line. The median relative dose intensity (RDI) of irinotecan was 60.6%, which is lower than that in the pivotal phase 3 study (RAISE), and other agents showed the same trend. Median progression-free survival was 4.8 [95% confidence interval (CI) 3.2–5.7] months for all patients, 5.4 (95% CI 3.5–7.2) months for second-line patients, and 2.8 (95% CI 1.6–5.8) months for third or later-line patients. Median overall survival was 17.3 (95% CI 11.5–22.4) months for all patients. Patients with irinotecan RDI less than 60% showed similar treatment efficacy. Hematological toxicities of grade 3 or worse were observed in 21 patients, but all were manageable.

Conclusion

Low RDI did not compromise the treatment efficacy of ramucirumab plus modified FOLFIRI for MCRC patients.

Keywords

Colorectal cancer Ramucirumab Irinotecan Relative dose intensity 

Notes

Acknowledgements

The authors would like to thank all the participating patients and medical staff who treated the patients in each institution.

Compliance with ethical standards

Conflict of interest

Akitaka Makiyama have received a speaker honorarium from Eli Lilly. Taito Esaki has received a speaker honorarium from Daiichi Sankyo and Eli Lilly and has received research grants from Daiichi Sankyo. Koichi Akashi has received speaker honorarium from Kyowa Hakko Kirin. Koichi Akashi has received research grants from Kyowa Hakko Kirin, Yakult, Eli Lilly and Daiichi Sankyo. Eishi Baba has received a speaker honorarium and research grants from Eli Lilly. The other authors have no conflict of interest.

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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Tomoyasu Yoshihiro
    • 1
  • Hitoshi Kusaba
    • 1
  • Akitaka Makiyama
    • 2
  • Kazuma Kobayashi
    • 3
  • Masato Uenomachi
    • 1
  • Mamoru Ito
    • 1
  • Yasuhiro Doi
    • 4
  • Kenji Mitsugi
    • 4
  • Tomomi Aikawa
    • 5
  • Kotoe Takayoshi
    • 5
  • Taito Esaki
    • 5
  • Hozumi Shimokawa
    • 6
  • Kenji Tsuchihashi
    • 1
  • Hiroshi Ariyama
    • 1
  • Koichi Akashi
    • 1
  • Eishi Baba
    • 7
  1. 1.Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan
  2. 2.Department of Hematology/OncologyJapan Community Healthcare Organization Kyushu HospitalKitakyushu, FukuokaJapan
  3. 3.Department of SurgeryNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of Medical OncologyHamanomachi HospitalFukuokaJapan
  5. 5.Department of Gastrointestinal and Medical OncologyNational Kyushu Cancer CenterFukuokaJapan
  6. 6.Department of Medical Oncology, Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuokaJapan
  7. 7.Department of Comprehensive Clinical Oncology, Faculty of Medical SciencesKyushu UniversityFukuokaJapan

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