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My wife had primary lower bowel cance about 4 years ago and she went through
conventional treatment e.g. chemo, radio,surgery and a bit more chemo. Her
weight was never normal or stable after than it was hard to 'keep it on' she
was saying. After her initial treatment she only received one colonoscopy
and one barium enema test a year after the operation. For three years
doctors relied on 6 monthly markers (and were saying that all is ok) to
monitor and treat her condition. This did not work because the cancer
metastised in Mar (seen on ct scans but the tumours began to form much
earlier I suppose before they can be seen in the ct). Only now we find that
markers are notoriously unrealiable. Previously our guard was down.....if we
knew we could have tried some (any) kind of alternative remedy.When I ask doctors why they did not give her interim treatment to try to
avoid metastasis they said to me it because of resistance and toxicity e.g.
cancer cells become immune and resistent to chemo as in anitibiotics etc.
Also, they are toxic. Yet now with the metastisised cancer they want to resume treatment with
chemo 5fu and oxaliplatin. I don't have much faith in this. Does any body
know if these drugs will do more good than harm?
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Median means 50% did better, 50% worse. Another here, seems to imply that this Oxaliplatin is more expensive but really doesn't
improve on previous types of combos in the NICE study.
http://www.druginfozone.nhs.uk/Record%20Viewing/viewRecord.aspx?id=53... Oxaliplatin is currently licensed for treatment of metastatic colorectal cancer in
combination with 5-fluorouracil and folinic acid. Irinotecan is licensed to be used in
combination with 5-fluorouracil and folinic acid in patients without prior chemotherapy for
advanced disease, and as a single agent in patients who have failed an established
5-fluorouracil containing treatment regimen. NICE assessed the evidence to support the first-line use of oxaliplatin and irinotecan in
March 2002 and provided the following guidance
· On the balance of clinical and cost-effectiveness, neither irinotecan nor oxaliplatin in
combination with 5-fluorouracil and folinic acid (5FU/FA) are recommended for routine
first-line therapy for advanced colorectal cancer.
· Oxaliplatin should be considered for use as a first-line therapy in combination with
5FU/FA, in advanced colorectal cancer in patients with metastases that are confined solely to
the liver and may become resectable (down staged) following treatment.
However this guidance has been widely criticised - the DTB concluded that recommendations
against first-line use of oxaliplatin or irinotecan appear to rest heavily on analyses of
data on cost-effectiveness. The published evidence base assessing the incremental benefit of adding oxaliplatin or
irinotecan to 5FU/FA has not really changed since NICE issued their guidance in March 2002
although several studies have been reported in abstract form which support the findings of
the published studies Overall it would appear that there is evidence to suggest that either oxaliplatin or
irinotecan used in combination with a 5FU/FA based regimen as a first –line treatment of
advanced disease extends median progression-free survival by 2-3 months. It may also extend
overall survival but given the use of salvage therapies in the control groups it is not
possible to accurately quantify this effect. A recently published study attempted to assess the effect of sequencing of two combination
regimens on outcomes in patients presenting with metastatic colorectal cancer.. In this study
previously untreated patients were randomised to receive either FOLFIRI (fluorouracil,
folinic acid and irinotecan) followed by FOLFOX6 (simplified fluorouracil, folinic acid plus
oxaliplatin) or FOLFOX6 followed by FOLFIRI. Patients were switched after disease progression
or if unacceptable toxicity occurred. Median overall survival was 21.5 months for patients
that received FOLFIRI followed by FOLFOX6 and 20.6 months for the patients that received the
reverse sequence. Use of an oxaliplatin-based or irinotecan-based regimen is associated with an increased risk
of toxicity. For oxaliplatin, neutropenia (an excess of 34% experienced Grade 3-4
neurotoxicity in one study) and neurosensory toxicity (an excess of 18% experienced
peripheral neuropathy in one study) are of particular concern. For irinotecan, diarrhoea (an
excess of around 15%) and alopecia may be of concern. There is also data indicating that use
of bolus-based irinotecan 5FU/FA regimens may be associated with a 3-fold (or 2% absolute)
increase in the risk of treatment-induced or treatment-exacerbated death. In terms of drug costs a combination regimen is approximately between £1000 and £1500 more
expensive per treatment month than the other regimens used in this condition. Given that up
to 18 people per 100,000 population are expected to receive chemotherapy for advanced
colorectal cancer, and that they are likely to receive between 3 and 6 months treatment a
complete switch to an irinotecan or oxaliplatin-based regimen could increase annual drug
costs by between £54,000 and £162,000 per 100,000 population and total treatment costs by
between £54,000 and £270,000 per 100,000 population.
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