Oral Alternative for Treatment of Colon Cancer
Results from a recent multi-institutional trial have demonstrated that capecitabine, an oral chemotherapy agent, provides similar treatment outcomes to 5-Fluorouracil (5-FU) plus Leucovorin(LV) and allows patients to be treated at home with fewer side effects.
Cancer of the colon and rectum is the second leading cause of cancer related deaths in the United States. Advanced colorectal cancer means that cancer has spread from its site of origin to distant places in the body, often invading vital organs. Chemotherapy remains an essential treatment component for this disease.
Most chemotherapy used for treating cancer is administered intravenously (through a vein). Intravenous (I.V.) infusion requires patients to receive treatment at a hospital or clinical setting staffed with trained healthcare professionals. In addition, I.V. infusion is associated with infection, pain and increased medical costs. Therefore, researchers have recently been evaluating oral forms of chemotherapy in order to avoid the associated inconvenience of I.V. therapy.
Currently, the chemotherapy combination consisting of Camptosar®, 5-FU/LV, which is administered intravenously, is the standard initial treatment for the majority of patients with colon cancer. Based on the results of a recent clinical trial, capecitabine, an oral chemotherapy agent, may be substituted for 5-FU/LV in patients that fail initial therapy. Capecitabine gets converted to 5-FU through the metabolic processes of an enzyme (protein) called thymidine phosphorylase. Thymidine phosphorylase is predominantly active in cancer cells, strategically creating high levels of 5-FU from capecitabine within cancer cells.
Researchers recently conducted a multi-institutional clinical trial directly comparing capecitabine to 5-FU/LV in the treatment of patients with advanced colon cancer. The overall initial anti-cancer response rate following therapy was 25.8% for patients receiving capecitabine compared with 11.6% for patients receiving 5-FU/LV. The average time to disease progression and length of overall survival were statistically similar between the two patient groups. Of significant importance was the decrease in side effects caused by capecitabine compared with 5FU/LV. Significantly fewer patients taking capecitabine were hospitalized due to adverse treatment complications compared with patients who received 5-FU/LV. Medical expenses and resources were dramatically reduced in the group of patients receiving capecitabine due to the avoidance of hospitalization for I.V. treatment, less expensive drug therapy to treat treatment-related side effects, and fewer hospitalizations due to treatment-related side effects. In addition, capecitabine is taken at home which provides the patient more comfort and convenience.
The results of this study indicate similar outcomes of capecitabine to 5-FU/LV. Patients with advanced colon cancer who may be receiving 5-FU/LV may wish to speak with their physicians about receiving capecitabine as an alternative, given the convenience and similar efficacy to 5-FU/LV. Additionally, capecitabine appears to create significantly fewer side effects and enables patients to remain at home for treatment. Clinical trials evaluating capecitabine as a substitute for 5-FU/LV in the initial treatment of colon cancer will begin in the near future, re-evaluating first-line treatment for this disease. Patients with colon cancer may wish to speak with their physician about the risks and benefits of capecitabine or the participation in a clinical trial evaluating novel treatment strategies. Two sources of information about ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and
Journal of Clinical Oncology, Vol 19, No 8, pp 2282-2292) (
European Journal of Cancer, Vol 37, No 5, pp 597-604, 2001)
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