Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741

Abstract

Purpose: In this report, we update survival (OS) and time-to-progression (TTP) data for the Intergroup trial N9741 after a median 5 years of follow-up by using risk-stratified and prognostic factor analyses to determine if treatment outcomes differ in specific patient subgroups.

Patients and methods: A total of 1,691 patients were randomly assigned to one of seven fluorouracil-, oxaliplatin-, and irinotecan-containing regimens. OS and TTP were calculated by treatment arm and baseline risk group (on the basis of WBC, performance status, number of sites of disease, and alkaline phosphatase). Multivariate prognostic factor analysis was used to assess clinical factors for their relationships to OS, TTP, response, and toxicity by using Cox and logistic regression models.

Results: The observed 5-year survival with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX) of 9.8% was better than with irinotecan plus bolus fluorouracil and leucovorin (IFL; 3.7%; P = .04) or with bolus irinotecan/oxaliplatin (IROX; 5.1%; P = .128). OS and TTP were significantly longer for FOLFOX (20.2 months and 8.9 months, respectively) than for IFL (14.6 months and 6.1 months, respectively; P < .001 for both) or for IROX (17.3 months and 6.7 months, respectively; P < .001 for both). OS differed by risk group: 20.7 months for low risk, 17.4 months for intermediate risk, and 9.4 months for high risk (P < .001). FOLFOX treatment was superior in all risk groups and was the most powerful prognostic factor for OS, TTP, response rate, and toxicity.

Conclusion: The 9.8% 5-year OS in patients with metastatic colorectal cancer who were treated with first-line FOLFOX sets a new benchmark. Neither baseline risk group nor any prognostic factor examined was predictive of treatment-specific outcome. However, treatment efficacy and patient longevity varied as a function of risk group.

Fig 1.

(A) Overall survival and (B) time to progression. IFL, irinotecan plus bolus fluorouracil and leucovorin; FOLFOX, oxaliplatin, fluorouracil, and leucovorin; IROX, irinotecan and oxaliplatin.

Fig 2.

Overall survival (OS) by baseline risk: (A) OS by risk group; (B) OS by performance status (PS).

Fig 3.

Multivariate prognostic factor analysis: (A) Overall survival; (B) time to progression; (C) response rate; (D) any grade ≥ 3 toxicity. Trt, treatment; IFL, irinotecan plus bolus fluorouracil and leucovorin; FOLFOX, oxaliplatin, fluorouracil, and leucovorin; IROX, irinotecan and oxaliplatin; ECOG PS, Eastern Cooperative Oncology Group performance status; Hgb, hemoglobin; ANC, absolute neutrophil count; BMI, body mass index; Adj., adjuvant; ALK, alkaline phosphatase; Tot Bili, total bilirubin.