Fluorouracil and folinic acid bolus schedule (nordic regimen) combined with irinotecan as a first-line chemotherapy in metastatic colorectal cancer

The recent incorporation of irinotecan (CPT-11) for the management of advanced colorectal cancer has generated further improvement in survival. The goal of this retrospective analysis was to evaluate the efficacy and toxicity of irinotecan plus bolus FU/FA (Nordic regimen) as first-line therapy in patients with advanced colorectal cancer. A total of 43 patients with metastatic colorectal cancer treated with irinotecan plus bolus FU/FA (Nordic regimen) as first-line chemotherapy were reviewed. Patients with metastatic adenocarcinoma of the colon or rectum and who had measurable disease and WHO performance status of 2 or less were treated with irinotecan 210 mg/m2 as a 30-90 min intravenous infusion on day 1, followed by 5-FU 500 mg/m2 and FA 60 mg/m2 bolus on days 1 and 2, every 2 weeks, until disease progression or unacceptable toxicity. Patients were evaluated for response rates, survival and toxicity. Median patient age was 56 (29-76) years. Response rates were 72% as a carcino embryogenic antigen (CEA) level and 45% as a clinic evaluation. Disease control rates were 76% as a CEA level and 80% as a clinic evaluation. Median duration of response was 5,8 (2-9) months as a clinic evaluation and median duration of response was 6,6 (2-11) months as a CEA level. Median progression free interval was 9 (2-13) months and median overall survival was 16 (3-18) months. Grade 3-4 neutropenia occurred in 30% of the patients. Non-haematological toxicities were mild. There was no treatment-related death. Irinotecan - Nordic regimen is considered as a reasonable option for first-line treatment of patients with metastatic colorectal cancer