Raadpleeg ook literatuurlijst niet-toxische stoffen en behandelingen specifiek bij vormen van darmkanker van arts-bioloog drs. Engelbert Valstar.

Zie ook gerelateerde artikelen voor effectiviteit van de verschillende vormen van chemo voor darmkanker.

7 oktober 2019: Bron: Journal of Clinical Oncology

Standaard eerstelijns voor uitgezaaide endeldarmkanker is vooraf aan een operatie 4 tot 6 kuren met chemo plus eventueel radiotherapie. En na operatie nog eens 4 tot 6 kuren met chemotherapie. Heel veel patienten krijgen als chemo mFOLFOX6 die is samengesteld met gemodificeerde fluorouracil via infuus, leucovorin, en oxaliplatin. Echter uit een fase III studie blijkt nu dat de toevoeging van oxaliplatin geen enkel effect heeft op de 3-jaars overall overleving en de kans op een recidief.

In een Chinese multicenter, open-label, fase III-studie, werden mFOLFOX6 (gemodificeerd infuus fluorouracil, leucovorin en oxaliplatin) met of zonder radiotherapie versus infuus fluorouracil plus radiotherapie geëvalueerd in de neoadjuvante setting voor de behandeling van 495 patiënten met stadium II / III rectumkanker.

Ondanks de toevoeging van oxaliplatine, was de 3-jaars kans op lokaal recidief na R0 / R1-resectie en de 3-jaars totale overleving vergelijkbaar in alle drie de groepen. Respectievelijk: 91.3%, 89.1%, and 90.7% (P = .971 by log-rank test)

Ook was er geen verschil tussen wel of geen radiotherapie naast oxaliplatin. Ondanks dat mFOLFOX6 wel een betere respons gaf op de behandeling vooraf aan de operatie was de overall overleving en kans op een recidief gelijk bij alle drie de groepen. 

Hier de grafieken van de drie groepen:

Figure

FIG 2.Kaplan-Meier estimates of (A) disease-free survival (DFS), (B) locoregional recurrence after R0/1 resection, and (C) overall survival (OS) in the intention-to-treat population. FU, fluorouracil; HR, hazard ratio; mFOLFOX6, modified infusional fluorouracil, leucovorin, and oxaliplatin; RT, radiotherapy.

Het volledige studierapport is gratis in te zien: Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial

Hier het abstract van de studie:

In the multicenter, open-label, phase III FOWARC trial, modified infusional fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus radiotherapy resulted in a higher pathologic complete response rate than fluorouracil plus radiotherapy in Chinese patients with locally advanced rectal cancer. Here, we report the final results.

Adults ages 18 to 75 years with stage II/III rectal cancer were randomly assigned (1:1:1) to five cycles of infusional fluorouracil (leucovorin 400 mg/m2, fluorouracil 400 mg/m2, and fluorouracil 2.4 g/m2 over 48 hours) plus radiotherapy (46.0 to 50.4 Gy delivered in 23 to 25 fractions during cycles 2 to 4) followed by surgery and seven cycles of infusional fluorouracil, the same treatment plus intravenous oxaliplatin 85 mg/m2 on day 1 of each cycle (mFOLFOX6), or four to six cycles of mFOLFOX6 followed by surgery and six to eight cycles of mFOLFOX6. The primary end point was 3-year disease-free survival (DFS).

In total, 495 patients were randomly assigned to treatment. After a median follow-up of 45.2 months, DFS events were reported in 46, 39, and 46 patients in the fluorouracil plus radiotherapy, mFOLFOX6 plus radiotherapy, and mFOLFOX6 arms. In each arm, the probability of 3-year DFS was 72.9%, 77.2%, and 73.5% (P = .709 by the log-rank test), the 3-year probability of local recurrence after R0/1 resection was 8.0%, 7.0%, and 8.3% (P = .873 by the log-rank test), and the 3-year overall survival rate was 91.3%, 89.1%, and 90.7% (P = .971 by log-rank test), respectively.

mFOLFOX6, with or without radiation, did not significantly improve 3-year DFS versus fluorouracil with radiation in patients with locally advanced rectal cancer. No significant difference in outcomes was found between mFOLFOX6 without radiotherapy and fluorouracil with radiotherapy, which requires additional investigation of the role of radiotherapy in these regimens.

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