According to a recent article published in Oncology, the chemotherapy combination referred to as Xelox (Xeloda® and Eloxatin®) appears to be a highly effective regimen for patients with advanced colorectal cancer who have received prior chemotherapy.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Once the cancer has spread to distant sites in the body, it is referred to as metastatic cancer. At this stage, treatment is generally aimed at prolonging survival and improving quality of life. Chemotherapy remains the cornerstone of treatment for patients with metastatic colorectal cancer. Initial treatment often includes chemotherapy regimens consisting of Camptosar® (irinotecan), Eloxatin® (oxaliplatin), or Fluoroplex® (5-fluorouracil). Researchers are evaluating optimal chemotherapy regimens for patients who stop responding to initial chemotherapy as treatment options for these patients are still being defined.

Researchers from Italy recently conducted a clinical trial to evaluate the combination of Xeloda (capecitabine) plus Eloxatin (oxaliplatin), (known as Xelox when combined) in a new administration schedule for patients with advanced colorectal cancer. This trial included 36 patients with metastatic colorectal cancer who had stopped responding to prior chemotherapy. Forty-four percent had received one prior chemotherapy regimen consisting of 5-fluorouracil and/or Camptosar-based chemotherapy; 56% had received two prior chemotherapy regimens consisting of these agents; and 33% had stopped responding to prior Eloxatin-based chemotherapy. Treatment was administered over a 21-day cycle. Eloxatin was administered into a vein (intravenously) for 12 hours continuously on the first and eighth days of the 21-day cycle, and Xeloda was administered orally at 8:00 am (25% of dose), 6:00 pm (25% of dose), and 11:00 pm (50% of dose) every day for the first 14 days of the 21-day cycle (chronomodulated administration).

A majority, over 66%, of patients achieved an anticancer response or disease stabilization with the Xelox regimen. Among patients who had stopped responding to prior Eloxatin-based therapy, nearly 70% achieved an anticancer response or disease stabilization. The average time before cancer progressed was nearly 7 months, and over half of the patients (54%) were still alive at one year following therapy. The most common severe side effects were weakness, fatigue, and diarrhea.

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The researchers concluded that Xelox administered according to this novel schedule yields high anti-cancer response rates and prolongs survival in this group of heavily pre-treated patients with metastatic colorectal cancer, including those who stopped responding to prior Eloxatin-based chemotherapy. Given the fact that this regimen was fairly well tolerated, the researchers state that these results warrant future trials. Patients with recurrent, metastatic colorectal cancer may wish to speak with their physician regarding their individual risks and benefits of participation in a clinical trial further evaluating Xelox or other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Santini D, Vincenzi B, La Cesa A, et al. Continuous Infusion of Oxaliplatin plus Chronomodulated Capecitabine in 5-fluorouracil- and Irinotecan-Resistant Advanced Colorectal Cancer Patients. Oncology. 2005; 69:27-34.

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