News
First-line bevacizumab with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) improves survival outcomes in patients with metastatic colorectal cancer, according to a new trial. Patients with this disease had been more responsive to chemotherapy with FOLFOXIRI than to fluorouracil, leucovorin, and irinotecan (FOLFIRI). The advent of bevacizumab raised the question as to whether its addition to FOLFOXIRI would be more efficacious. In a phase 2 study of FOLFOXIRI plus bevacizumab, Masi and colleagues reported acceptable incidences of toxic effects and encouraging activity. In the new study, Fotios Loupakis and colleagues report data from the TRIBE study,in which 508 patients with untreated metastatic colorectal cancer were randomly assigned to receive bevacizumab with either FOLFIRI (control group) or FOLFOXIRI
(experimental group) for up to 12 cycles of treatment to be administered, followed by fluorouracil plus bevacizumab until tumour progression. The primary endpoint was progressionfree survival. Investigators reported a median progression-free survival of 12·1 months in the FOLFOXIRI plus bevacizumab group compared with 9·7 months in the group receiving FOLFIRI plus bevacizumab (hazard ratio [HR] 0·75 [95% CI 0·62–0·90]; p=0·003). The objective response rate was 65% in the experimental group and 53% in the control group (p=0·006). Overall survival was 31·0 months in the experimental group compared with the 25·8 months in the control group (HR for death, 0·79 [95% CI 0·63–1·00]; p=0·054). In the experimental group, significantly higher incidences of grade 3–4 adverse events, including neurotoxicity, stomatitis, diarrhoea,
and neutropenia, were recorded than in the control group. John Bridgewater, University College Hospital London (London, UK), commented, “These data suggest it is feasible to deliver multiple drug therapy in patients with first-line colorectal cancer with excellent outcomes. Additonal detail about the choices for second and third line treatment would be helpful, although that might be difficult to obtain.” Robert Glynne-Jones (Mount Vernon Cancer Centre, London, UK) added, “findings from this trial are exciting and shows that FOLFOXIRI with bevacizumab has an acceptable profile of toxic profile. However, this is a small trial and probably too underpowered to show an overall survival benefit and therefore, larger scale trials are advocated.”
Zephyr/Science Photo Library
FOLFOXIRI and bevacizumab in metastatic colorectal cancer
Published Online October 31, 2014 http://dx.doi.org/10.1016/ S1470-2045(14)71112-X For the study by Loupakis and colleagues see N Engl J Med 2014; 371: 1609–18 For the study by Masi and colleagues see Lancet Oncol 2010; 11: 845–52
Ahmadur Rahman
Late detection of lung cancer 30% of patients with lung cancer die within 90 days of diagnosis, according to a new study. Moreover, these patients usually had more interactions with primary care before their diagnosis (median of five consultations) than patients with lung cancer who survived for longer than 90 days (median of four consultations), which could suggest missed opportunities in identification of patients with this disease. From the Health Improvement Network Database, O’Dowd and colleagues extracted all diagnoses of lung cancer in the UK for 2000–13. After exclusions, the data set consisted of 20 142 people with lung cancer. 5% of patients were diagnosed on their death certificate, 10% died within 30 days of diagnosis, and 15% died between 31 days and 90 days of diagnosis. Factors associated with early death included: being male (odds
ratio [OR] 1·17, 95% CI 1·10–1·24); currently smoking (1·43, 1·28–1·61); and increasing age (1·80, 1·62–1·99 for people aged 80 years or older compared with those aged 65–69 years). These factors, implicit of worse general health, might account for the disparity in consultations between patients who died early and those who survived for longer (the database does not provide information on the nature of interactions between patients and family doctor). “I suspect that patients who had more consultations could have been presenting with non-specific symptoms, so general practitioners did not initially think of an underlying diagnosis of lung cancer”, added lead author Emma O’Dowd (University of Nottingham, UK). The researchers also noted that practices that had high rates of referrals for chest x-rays did not see a reduction
www.thelancet.com/oncology Vol 15 December 2014
in premature deaths. “They [general practitioners] weren’t detecting lung cancer at an early enough stage to confer a survival benefit to the patient”, explained O’Dowd, who added that better identification is needed to find “the right patients to do a chest x-ray on at the right time”. On average, GPs see a new patient with lung cancer every year. Risk stratification methods could help with making an early diagnosis, an area in which the UK does worse than most other European nations. “Techniques are available that will give the GP a risk estimate based on specific symptoms, the risk for that patient having undiagnosed lung cancer”, explained Bangor University’s Richard Neal. “But at the moment they don’t say what level of risk should be investigated, and they are largely based around people with respiratory symptoms”.
Published Online October 31, 2014 http://dx.doi.org/10.1016/ S1470-2045(14)70371-7 For the study by O’Dowd and colleagues see Thorax 2014; published online Oct 13. DOI: 10.1136/ thoraxjnl-2014-205692
Talha Khan Burki e590
First-line bevacizumab with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) improves survival outcomes in patients with metastatic colorectal cancer, according to a new trial. Patients with this disease had been more responsive to chemotherapy with FOLFOXIRI than to fluorouracil, leucovorin, and irinotecan (FOLFIRI). The advent of bevacizumab raised the question as to whether its addition to FOLFOXIRI would be more efficacious. In a phase 2 study of FOLFOXIRI plus bevacizumab, Masi and colleagues reported acceptable incidences of toxic effects and encouraging activity. In the new study, Fotios Loupakis and colleagues report data from the TRIBE study,in which 508 patients with untreated metastatic colorectal cancer were randomly assigned to receive bevacizumab with either FOLFIRI (control group) or FOLFOXIRI
(experimental group) for up to 12 cycles of treatment to be administered, followed by fluorouracil plus bevacizumab until tumour progression. The primary endpoint was progressionfree survival. Investigators reported a median progression-free survival of 12·1 months in the FOLFOXIRI plus bevacizumab group compared with 9·7 months in the group receiving FOLFIRI plus bevacizumab (hazard ratio [HR] 0·75 [95% CI 0·62–0·90]; p=0·003). The objective response rate was 65% in the experimental group and 53% in the control group (p=0·006). Overall survival was 31·0 months in the experimental group compared with the 25·8 months in the control group (HR for death, 0·79 [95% CI 0·63–1·00]; p=0·054). In the experimental group, significantly higher incidences of grade 3–4 adverse events, including neurotoxicity, stomatitis, diarrhoea,
and neutropenia, were recorded than in the control group. John Bridgewater, University College Hospital London (London, UK), commented, “These data suggest it is feasible to deliver multiple drug therapy in patients with first-line colorectal cancer with excellent outcomes. Additonal detail about the choices for second and third line treatment would be helpful, although that might be difficult to obtain.” Robert Glynne-Jones (Mount Vernon Cancer Centre, London, UK) added, “findings from this trial are exciting and shows that FOLFOXIRI with bevacizumab has an acceptable profile of toxic profile. However, this is a small trial and probably too underpowered to show an overall survival benefit and therefore, larger scale trials are advocated.”
Zephyr/Science Photo Library
FOLFOXIRI and bevacizumab in metastatic colorectal cancer
Published Online October 31, 2014 http://dx.doi.org/10.1016/ S1470-2045(14)71112-X For the study by Loupakis and colleagues see N Engl J Med 2014; 371: 1609–18 For the study by Masi and colleagues see Lancet Oncol 2010; 11: 845–52
Ahmadur Rahman
Late detection of lung cancer 30% of patients with lung cancer die within 90 days of diagnosis, according to a new study. Moreover, these patients usually had more interactions with primary care before their diagnosis (median of five consultations) than patients with lung cancer who survived for longer than 90 days (median of four consultations), which could suggest missed opportunities in identification of patients with this disease. From the Health Improvement Network Database, O’Dowd and colleagues extracted all diagnoses of lung cancer in the UK for 2000–13. After exclusions, the data set consisted of 20 142 people with lung cancer. 5% of patients were diagnosed on their death certificate, 10% died within 30 days of diagnosis, and 15% died between 31 days and 90 days of diagnosis. Factors associated with early death included: being male (odds
ratio [OR] 1·17, 95% CI 1·10–1·24); currently smoking (1·43, 1·28–1·61); and increasing age (1·80, 1·62–1·99 for people aged 80 years or older compared with those aged 65–69 years). These factors, implicit of worse general health, might account for the disparity in consultations between patients who died early and those who survived for longer (the database does not provide information on the nature of interactions between patients and family doctor). “I suspect that patients who had more consultations could have been presenting with non-specific symptoms, so general practitioners did not initially think of an underlying diagnosis of lung cancer”, added lead author Emma O’Dowd (University of Nottingham, UK). The researchers also noted that practices that had high rates of referrals for chest x-rays did not see a reduction
www.thelancet.com/oncology Vol 15 December 2014
in premature deaths. “They [general practitioners] weren’t detecting lung cancer at an early enough stage to confer a survival benefit to the patient”, explained O’Dowd, who added that better identification is needed to find “the right patients to do a chest x-ray on at the right time”. On average, GPs see a new patient with lung cancer every year. Risk stratification methods could help with making an early diagnosis, an area in which the UK does worse than most other European nations. “Techniques are available that will give the GP a risk estimate based on specific symptoms, the risk for that patient having undiagnosed lung cancer”, explained Bangor University’s Richard Neal. “But at the moment they don’t say what level of risk should be investigated, and they are largely based around people with respiratory symptoms”.
Published Online October 31, 2014 http://dx.doi.org/10.1016/ S1470-2045(14)70371-7 For the study by O’Dowd and colleagues see Thorax 2014; published online Oct 13. DOI: 10.1136/ thoraxjnl-2014-205692
Talha Khan Burki e590
