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Modified XELIRI Versus Standard FOLFIRI in Metastatic Colorectal Cancer

By: Joseph Fanelli
Posted: Thursday, May 10, 2018

Modified XELIRI (capecitabine plus irinotecan) appears to be noninferior, in terms of overall survival, to standard FOLFIRI (leucovorin, fluorouracil, and irinotecan) as a second-line treatment of metastatic colorectal cancer. These results of the Asian phase III noninferiority AXEPT trial, published in The Lancet Oncology, were found with or without the use of bevacizumab.

“The results of this study suggest that modified XELIRI might be an effective, well tolerated, and more convenient alternative to FOLFIRI as a standard second-line backbone treatment for patients with metastatic colorectal cancer, at least for Asian patient populations,” concluded lead author Rui-Hua Xu, MD, of the Sun Yat-Sen University Cancer Center in China, and colleagues.

In the open-label trial, 650 patients were enrolled from 98 hospitals in China, Japan, and South Korea, with 326 receiving modified XELIRI and 324 receiving FOLFIRI, both with or without bevacizumab. In total, 83% of the modified XELIRI group and 84% of the FOLFIRI group received concomitant bevacizumab.

After a median follow-up of 15.8 months, the median survival in the modified XELIRI group was 16.8 months, compared with 15.4 months in the FOLFIRI group (hazard ratio of 0.85). Dr. Xu and colleagues found that the median progression-free survival (a secondary trial endpoint) did not seem to differ significantly with modified XELIRI and FOLFIRI (8.4 months vs. 7.2 months, respectively; hazard ratio of 0.95).

Grade ≥ 3 adverse events were observed in 54% of the modified XELIRI group and 72% of the FOLFIRI group, with the most common grade 3/4 adverse event being neutropenia (17% and 43%, respectively).


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