1 / 9

Case study two: XELIRI

Case study two: XELIRI. Yehuda Patt University of New Mexico Albuquerque, NM, USA. Rationale for combining Xeloda with irinotecan in MCRC. Xeloda generates 5-FU preferentially in tumor and has high single-agent, first-line activity

dick
Download Presentation

Case study two: XELIRI

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case study two: XELIRI Yehuda Patt University of New MexicoAlbuquerque, NM, USA

  2. Rationale for combining Xeloda with irinotecan in MCRC • Xeloda generates 5-FU preferentially in tumor and has high single-agent, first-line activity • Addition of irinotecan to 5-FU/LV improves efficacy of first-line treatment • Only partially overlapping key toxicities • Sequential combination of low doses of irinotecan plus Xeloda highly curative in vivo1 • MCRC is a chronic disease that must be managed over a considerable period of time • the following cases will show that XELIRI is an ideal part of multi-modality treatment in this situation 1Cao S et al. Proc Am Assoc Cancer Res 2001 (Abst 464)

  3. XELIRI US phase II trial:first-line in MCRC (n=52) 1 8 15 21 Day Irinotecan250mg/m2 (90-minute infusion) Xeloda1000mg/m2 twice daily Day 1 (pm)–15 (am) Rest Repeat cycle at day 22 • Male/female (%) = 56/44; median age = 58 years • Primary tumor = 84% colon, 12% rectum, 4% both • 14 patients 65 or who had received prior radiotherapy treated at 200/750 Patt YZ et al. Proc ESMO Annals Oncol 2004;15:iii88 (Abst 238P)

  4. XELIRI q3w: highly active first-line treatment for MCRC • Efficacy • ORR in 54% of patients evaluable for efficacy • median TTP 7.8 months • median overall survival 16.8 months • 8 of 24 patients treated at MDACC were subjected to successful liver/lung metastasis resection • Predictable and manageable safety profile • predominantly mild-to-moderate adverse events • no treatment-related deaths Patt YZ et al. Proc ESMO Annals Oncol 2004;15:iii88 (Abst 238P)

  5. XELIRI case • July 2002: 58-year-old man diagnosed with Dukes’ C (T3,N1,MX) colon carcinoma • He underwent a hemicolectomy with surgical resectionof the primary tumor • August 2002: detection of bilobar liver metastasis and a single lung metastasis • August 2002 to July 2003: he received 15 cycles of XELIRI • ≤ grade 2 diarrhea, managed with dose modificationand anti-diarrheals • ≤ grade 2 hand-foot syndrome managed with dose modification and emollients • July 2003: complete remission of liver lesions and stable disease of lung metastasis

  6. CT scans showing metastases before and after treatment with XELIRI August 2002 May 2003

  7. Hemicolectomy Liver and lungmetastases CR in liverSD in lung Oxaliplatindiscontinued Resection oflung metastases Recurrencein lung 15 x XELIRI 15 x 5-FU/LV+ Avastin 4 xFOLFOX6+ Avastin mFOLFOX6/Avastin on trial Dose adjustments prn 4 x XELIRI CEA plotting in correlationwith medical interventions ng/mL 8 7 6 5 4 3 2 1 0 Jan 03 Jan 04 Jan 05 Mar 03 Mar 04 Mar 05 Nov 02 Nov 03 Nov 04 May 03 May 04 May 05 July 02 July 03 July 04 Sept 02 Sept 03 Sept 04

  8. May1998 May2005 4 xXELIRI Disease free T2,N1,M0Stage IIIrectalcancer 5-FU + radiation 6 xXELIRI The role of biology • 60-year-old woman with T2,N1,M0 rectal cancer Jan2002 April2002 May2002 Oct2002 Sept1998 Feb 1999 1 liver metastasis Resectionof liver metastasis(pCR)

  9. XELIRI: an effectivefirst-line option for MCRC • Patients achieve the best survival by sequencing multi-modal interventions • resection may become feasible after systemic therapy • XELIRI can be given for an extended period • key to maximizing first-line duration of response • Aggressive management of side-effects imperative • side effects such as neutropenia, nausea and vomiting were effectively managed with dose reduction • Xeloda is the ideal combination partner as its oral formulation and flexibility of dosing allow long-term use • demonstrated by up to 19 cycles of XELIRI

More Related