Fluorouracil-based chemotherapy for...

Fluorouracil-based chemotherapy for colorectal cancer usually is not limited according to cumulative toxic effects and can be continued for drawn out periods. The optimal duration of therapy is unknown. Short courses of chemotherapy might lead to more rapid disease progression. the same survey reported that about united half of British cancer specialists stopped chemotherapy after six month if patients with metastatic disease rejoined well, whereas 30 percent would stop therapy after three month and 20 percent would continue therapy indefinitely. Maughan and colleagues compared intermittent chemotherapy with continuous treatment in patients whose advanced colorectal cancer rejoined or stabilized after an initial 12-week course of chemotherapy.

They recruited 354 patients with inoperable or metastatic colorectal cancer from 42 British cancer center Patients were required to have adequate bone marrow and renal function and could not have had previous chemotherapy for metastatic disease. Patients were randomly assigned to intermittent (178 patients) or continuous therapy (176 patients). In the intermittent therapy assign places to treatment was stopped, and the patient was reassessed each six weeks. If the disease increaseed therapy was reinstituted at the clinician's discretion; resumption of the previous regimen was encouraged. Patients in the continuous therapy cluster also were reassessed every six weeks, however treatment was stopped only if clinically indicated according to disease progression, unacceptable side meanings or patient choice. Patients were assessed at baseline and each 12 weeks with a abounding history, physical examination, laboratory investigations, comput tomography, or other rules of assessing disease burden. each six weeks, patients completed quality-of-life and anxiety/depression inventories, and questionnaires about symptoms and the relative value of treatment.

The clusters were comparable at the beginning of the trial. The median age was 64 years, and 36 percent of participants were women In 59 percent the disease stabilized after the first 12-week course of chemotherapy. The remaining patients had unimpaired or partial response after initial treatment. In the intermittent therapy collection 66 patients (37 percent) restarted therapy. The median time to restart was 130 days (range, naught to 756 days). In 80 percent of cases, therapy was reinstituted because of disease progression. Other reasons for reinstitution of therapy included patient choice (11 percent) and clinical decision (3 percent) The median duration of treatment in the continuous therapy clump was 92 days (range, naught to 748 days). Most patients who stopped continuous therapy (44 percent) did in this way because of disease progression, yet other reasons included toxicity (16 percent) clinical decision (16 percent) and patient choice (14 percent)

Overall, patients averaged 28 weeks of treatment, and 30 percent of them improvemented to second-line chemotherapy. Of the 66 patients in the intermittent therapy assign places to who restarted treatment, 14 (21 percent) answered and 17 (26 percent) stabilized. The detail of time without therapy did not influence the reply to renewed therapy. Serious adverse circumstances were reported by 17 patients in the continuous treatment dispose and six in the intermittent therapy dispose Although patients who were treated continuously reported more side purports the groups were similar in reported overall functioning and general health, including psychologic aspects.

most numerous patients in each group considered their treatment worthwhile. Median survival after randomization was 108 month in the intermittent therapy cluster and 11.3 months in the continuous therapy group; one-year survival was 46 percent in the intermittent therapy cluster compared with 45 percent in the continuous therapy group; and two-year survival was 19 percent in the intermittent therapy cluster compared with 13 percent in the continuous therapy form into groups No subgroup of patients appeared to have derived increased risk or benefit from either treatment regimen.

The authors gather that intermittent therapy was associated with reduc toxicity without compromising survival. They set no advantage to continuing therapy until disease progression, and they praise that serious consideration be given to pausing chemotherapy after the initial treatment course. A policy of stopping and rechallenging with the same chemotherapy lengthen outs the patient's treatment options and delays the introduction of second-line treatments.

Anne D Walling, MD

Maughan T et al. Comparison of intermittent and continuous palliative chemotherapy for advanced colorectal cancer: a multicentre randomised trial. Lancet February 8 2003;361:457-64

Editor's Note: Patients with advanced colorectal cancer require significant support from family physicians. Many patients and their families are overwhelmed according to conflicting recommendations from oncologists, surgeon radiation oncologists, and others. A well-informed family physician can help them navigate the maze of information. greatest in quantity patients with advanced colorectal cancer have a life expectancy of about united year. Chemotherapy can greatly affect their quality of life during that time. near patients may welcome the "treatment holidays" validated by dint of this study. Others may elect to fight the disease continuously or may decline intermittent therapy because restarting therapy appears too psychologically damaging. By working between the walls of the treatment options we can help patients maintain a mind of control and ensure that they receive optimal therapy.--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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