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Research ArticleClinical Studies

The Efficacy of Gemcitabine as Salvage Treatment in Patients with Refractory Advanced Colorectal Cancer (CRC): A Single Institution Experience

MUHAMMAD WASIF SAIF, KRISTIN KALEY, ROBIN PENNEY, SUSAN HOTCHKISS, KOSTAS N. SYRIGOS and ALEXIOS S. STRIMPAKOS
Anticancer Research September 2011, 31 (9) 2971-2974;
MUHAMMAD WASIF SAIF
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  • For correspondence: mws2138@columbia.edu
KRISTIN KALEY
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ROBIN PENNEY
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SUSAN HOTCHKISS
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KOSTAS N. SYRIGOS
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ALEXIOS S. STRIMPAKOS
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Abstract

Objective: To assess the efficacy of gemcitabine based chemotherapy in heavily pre-treated patients with advanced colorectal cancer. Patients and Methods: Patients, who had been treated with gemcitabine 1250-2000 mg/m2biweekly in combination with capecitabine 1700-2000 mg/m2/day, d1-7 every two weeks were retrospectively reviewed. All the patients had previously received at least three chemotherapy regimens and 12 (55%) had also received a 4th line regimen. All the patients had been treated with a monoclonal antibody either against vascular endothelial growth factor receptor (VEGFR) or endothelial growth factor receptor (EGFR) (only if wild-type KRAS). The patients had had blood tests weekly, carcinoembryonic antigen (CEA) level measurement every 4 weeks and radiological assessment of their disease with CT scans every 8/9 weeks. Results: Twenty two patients were included; male-female, 14:8; age ranged from 43-73 years. The majority of the patients (17/22) had performance status (PS) ECOG 0-1 and the remaining patients (5/22) had PS 2 at the time of initiation of the gemcitabine-based regimen. Thirteen patients demonstrated a clinical benefit (2 partial response, 2 minor response, 9 stable disease), 6 patients progressed and 2 were not evaluable. Conclusion: Gemcitabine has a modest activity in heavily pre-treated colorectal cancer patients and may be an option in good performance status patients.

  • Chemotherapy
  • fluorouracil
  • gemcitabine
  • colon cancer
  • capecitabine

Colorectal cancer (CRC) is the third commonest cancer diagnosed each year in the UK and in the United States and the second commonest cause of death among all cancer patients (1). The lifetime probability of developing CRC has been estimated to be 1 in 18 in men and 1 in 20 in women. At the time of diagnosis, synchronous metastases can been found in about 20% of patients (2, 3) and most patients with stage III or IV disease are likely to relapse within the first three years from diagnosis. Apart from the long existing class of fluoropyrimidines (thymidylate synthase inhibitors such as 5-fluorouracil and capecitabine), other cytotoxic drugs such as oxaliplatin, a third generation DNA cross linking platinum agent, and irinotecan, a topoisomerase-I inhibitor and hemisynthetic analogue of the natural compound camptothecan, are now considered as standard treatment options for advanced CRC (4, 5). There is, also, published evidence that the addition of monoclonal antibodies (cetuximab, panitumumab, bevacizumab), targeting the epidermal growth factor receptor (EGFR) or the vascular endothelial growth factor receptor (VEGFR), to the standard chemotherapy improves efficacy and overall survival in selected patients. When the aforementioned drugs have failed, regardless of the sequence or the combinations that have been used, no standard treatment exists, therefore new drugs need to be tested to expand the current options. Small phase II studies have provided some evidence of efficacy for some of the known cytotoxics in advanced multi-treated CRC patients. For example, the combination of mitomycin C with capecitabine in third line treatment of advanced CRC demonstrated an objective response rate of about 15% as well as disease stabilization of half of the patients (6).

The role of gemcitabine in CRC has not yet been established. Eight studies (two with phase I design and six phase II) evaluating the safety and efficacy of gemcitabine along with a fluoropyrimidine were found and reviewed by Merl et al. (7), who concluded that the combination is clinically active as demonstrated by a response rate of 30-38%, time to progression of 4-8.3% and median overall survival of 9.8 to over 18 months, with manageable toxicities. More recently, a randomized phase II study compared FOLFOX 4 (folinic acid, fluorouracil, oxaliplatin) to FFG (folinic acid, 5-fluorouracil, gemcitabine) in the 1st line setting of CRC, with the addition of bevacizumab allowed in both treatment arms after its Food and Drug Administration approval (8). Though, the study was closed prematurely due to poor accrual (84 patients enrolled of a planned 190), the authors concluded that gemcitabine has inferior efficacy and cannot replace oxaliplatin in this setting. Nevertheless, given the limited options in heavily pre-treated CRC patients, a drug with acceptable safety profile should be evaluated even if modest activity is expected. Thus, the present study, aimed to provide some evidence on the role of gemcitabine in advanced, pre-treated CRC patients.

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Table I.

Treatment design and follow up.

Patients and Methods

The efficacy, safety and toxicity data on patients at our institution diagnosed with cytologically or histologically proven metastatic colorectal adenocarcinoma who had been treated with gemcitabine (G) and capecitabine (C) salvage chemotherapy was retrospectively reviewed. According to institutional standards, all these patient had satisfactory bone marrow function (hemoglobin >9 g/dl; absolute neutrophil count >1500 cells/mm3 and platelet count >1000,000 cells/mm3); renal (serum creatine <1.5 mg/dl) and liver function (serum total bilirubin <1.5 mg/dl and serum transaminases <2.5 times the upper limit of laboratory normal) before the administration of GC chemotherapy. The treatment regimen consisted of gemcitabine at doses from 1250-2000 mg/m2 i.v. infusion over 30 min every 2 weeks and oral (PO) capecitabine 850-1000 mg/m2, twice a day, on days 1 to 7 every 2 weeks (Table I). The patients received GC as fourth or fifth-line treatment and continued until disease progression. Pre-emptive antiemetics included ondasetron (Zofron) 8 mg i.v. and dexamethasone 10 mg i.v. prior to the administration of gemcitabine according to the institutional guidelines. Furthermore, pegfilgrastim support was given prophylactically in patients receiving G ≥1500 mg/m2 on day 2 every 2 weeks.

Complete blood, platelet and differential counts and biochemistry profile were performed every two weeks. Toxicity was documented and graded according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0 (available at the webpage: http://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcaev3.pdf). Serum carcinoembryonic antigen (CEA) levels were measured every 4 weeks and CT scans were performed after every eight weeks until disease progression. Staging and radiological evaluation was performed according to the Response Evaluation Criteria in Solid Tumors (RECIST) (9). The reference range for CEA in our institution was <3 μg/L in non-smokers and <5 μg/L in smokers. The efficacy in terms of the response rate to the GC combination in heavily pre-treated patients was assessed.

Data was obtained from Electronic Patients Records included age, gender, performance status (PS, ECOG), type of previous chemotherapy regimens, doses of GC regimen and previous biological regimens. CT scan results and RECIST criteria were used for the measurement of response.

Results

Between January 2006 and February 2010, 22 advanced CRC patients had been treated with GC.

The patients' baseline characteristics are shown in Table II. Age ranged from 43 to 73 years and gender ratio (M:F) was 14:8. All the patients had previously received at least three chemotherapy lines and half of them (55%) a fourth line regimen as well. All 22 patients had also received bevacizumab and 70% (15/22) an EGFR inhibitor (cetuximab or panitumumab), while 30% (7/22) were tested mutant for KRAS and did not receive an EGFR inhibitor. PS was ECOG 0-1 in 17 patients and ECOG 2 in 5 patients. The median number of treatment cycles was 8 (range 4-14). The patients with PS ECOG 2 or who were ≥70 years of age were treated with the escalation dose schema.

Table III displays the response rates and duration of response (DoR) observed in the 22 treated patients. The disease control rate (DCR) was 59% (13/22) of which 9% was a partial response (PR) and 9% a good response, but not amounting to PR by RECIST. The duration of response for the two patients with PR was 6 months and 7.5 months respectively, and for the patients with a minor response 4 months (16 weeks). The DoR for the patients with stable disease ranged from 2 to 4 months.

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Table II.

Baseline characteristics.

Discussion

The combination of gemcitabine with capecitabine is well established and often used in advanced pancreatic cancer and less often in cholangiocarcinoma (10, 11). From an early dose escalation study, the combination of gemcitabine and capecitabine was found to be safe, well-tolerated and effective in pancreatic and CRC patients (12). There is evidence that gemcitabine may modify the pharmacokinetic properties of 5-FU, in vivo, and result thus in a synergistic effect (13). In a prospective study of gemcitabine in combination with protracted 5-FU infusion, as third line treatment of CRC, disease stabilization was achieved in about 60% of patients (10% of which being partial responses) (14).

Dose intensity of gemcitabine in preclinical models was associated with efficacy. Although a clear dose-response relation cannot be made in the clinical setting due to heterogeneity in regimens, doses and patients, doses of gemcitabine as high as 2,200 mg/m2 biweekly are known to be well tolerated, even in combination with capecitabine (15). The biweekly gemcitabine regimen has been an acceptable option in various other solid tumors, with good efficacy and even better convenience for patients (16-18). Similarly, the intermittent weekly capecitabine schedule has been found to be safe, well-tolerated and convenient, without compromising efficacy from the so far published data (15, 18).

In the present limited population experience, biweekly (every two weeks) schedule of gemcitabine delivery at 2000 mg/m2 with capecitabine at a flat dose of 1000-1500 mg PO BID for 7 days followed by 7 days off seemed to promise the greatest potential for dose intensification with least toxicity. Given the nature of toxicities observed on this schedule as well as the history of previous chemotherapy regimens in these patients, this regimen provided a good platform to administer pegylated filgrastim if indicated. This schedule is further supported by the study performed by Scheithauer et al. (15). However, it must be borne in mind that this study was constituted of chemo-naïve patients and haematological toxicity can be different. The present regimen needs to be explored, especially in KRAS mutant colon cancer patients and in those heavily pre-treated patients who for some reason haven't got the option of a clinical trial but are still fit enough to receive more treatment based on old drugs with modest activity, aiming for a longer disease control and better quality of life.

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Table III.

Treatment outcomes.

Conclusion

Evidence of disease control using the safe and well-tolerated combination of gemcitabine and capecitabine is demonstrated, which might allow oncologist to consider this option in selected CRC patients at advanced stages. Of course, high quality evidence can be only produced by properly designed prospective randomized studies.

  • Received April 22, 2011.
  • Revision received June 25, 2011.
  • Accepted June 28, 2011.
  • Copyright© 2011 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved

References

  1. ↵
    1. Jemal A,
    2. Siegel R,
    3. Ward E,
    4. Murray T,
    5. Xu J,
    6. Thun MJ
    : Cancer statistics, 2007. CA Cancer J Clin 57: 43-66, 2007.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Manfredi S,
    2. Lepage C,
    3. Hatem C,
    4. Coatmeur O,
    5. Faivre J,
    6. Bouvier AM
    : Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244: 254-259, 2006.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Benson AB III.
    : Epidemiology, disease progression, and economic burden of colorectal cancer. J Manag Care Pharm 13: S5-18, 2007.
    OpenUrlPubMed
  4. ↵
    1. de Gramont A,
    2. Figer A,
    3. Seymour M,
    4. Homerin M,
    5. Hmissi A,
    6. Cassidy J,
    7. Boni C,
    8. Cortes-Funes H,
    9. Cervantes A,
    10. Freyer G,
    11. Papamichael D,
    12. Le Bail N,
    13. Louvet C,
    14. Hendler D,
    15. de Braud F,
    16. Wilson C,
    17. Morvan F,
    18. Bonetti A
    : Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18: 2938-2947, 2000.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Cunningham D,
    2. Glimelius B
    : A phase III study of irinotecan (CPT-11) versus best supportive care in patients with metastatic colorectal cancer who have failed 5-fluorouracil therapy. V301 Study Group. Semin Oncol 26: 6-12, 1999.
    OpenUrlPubMed
  6. ↵
    1. Chong G,
    2. Dickson JL,
    3. Cunningham D,
    4. Norman AR,
    5. Rao S,
    6. Hill ME,
    7. Price TJ,
    8. Oates J,
    9. Tebbutt N
    : Capecitabine and mitomycin C as third-line therapy for patients with metastatic colorectal cancer resistant to fluorouracil and irinotecan. Br J Cancer 93: 510-514, 2005.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Merl M,
    2. Hoimes C,
    3. Pham T,
    4. Saif MW
    : Is there a palliative benefit of gemcitabine plus fluoropyrimidines in patients with refractory colorectal cancer? A review of the literature previously presented: poster at the 2008 Gastrointestinal Cancer Symposium (Abstract No. 512). Expert Opin Investig Drugs 18: 1257-1264, 2009.
    OpenUrlPubMed
  8. ↵
    1. Madajewicz S,
    2. Waterhouse DM,
    3. Ritch PS,
    4. Khan MQ,
    5. Higby DJ,
    6. Leichman CG,
    7. Malik SK,
    8. Hentschel P,
    9. Gill JF,
    10. Zhao L,
    11. Nicol SJ
    : Multicenter, randomized phase II trial of bevacizumab plus folinic acid, fluorouracil, gemcitabine (FFG) versus bevacizumab plus folinic acid, fluorouracil, oxaliplatin (FOLFOX4) as first-line therapy for patients with advanced colorectal cancer. Invest New Drugs, 2010.
  9. ↵
    1. Therasse P,
    2. Arbuck SG,
    3. Eisenhauer EA,
    4. Wanders J,
    5. Kaplan RS,
    6. Rubinstein L,
    7. Verweij J,
    8. Van Glabbeke M,
    9. van Oosterom AT,
    10. Christian MC,
    11. Gwyther SG
    : New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92: 205-216, 2000.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Iyer RV,
    2. Gibbs J,
    3. Kuvshinoff B,
    4. Fakih M,
    5. Kepner J,
    6. Soehnlein N,
    7. Lawrence D,
    8. Javle MM
    : A phase II study of gemcitabine and capecitabine in advanced cholangiocarcinoma and carcinoma of the gallbladder: a single-institution prospective study. Ann Surg Oncol 14: 3202-3209, 2007.
    OpenUrlCrossRefPubMed
  11. ↵
    1. Cunningham D,
    2. Chau I,
    3. Stocken DD,
    4. Valle JW,
    5. Smith D,
    6. Steward W,
    7. Harper PG,
    8. Dunn J,
    9. Tudur-Smith C,
    10. West J,
    11. Falk S,
    12. Crellin A,
    13. Adab F,
    14. Thompson J,
    15. Leonard P,
    16. Ostrowski J,
    17. Eatock M,
    18. Scheithauer W,
    19. Herrmann R,
    20. Neoptolemos JP
    : Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol 27: 5513-5518, 2009.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Schilsky RL,
    2. Bertucci D,
    3. Vogelzang NJ,
    4. Kindler HL,
    5. Ratain MJ
    : Dose-escalating study of capecitabine plus gemcitabine combination therapy in patients with advanced cancer. J Clin Oncol 20: 582-587, 2002.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Correale P,
    2. Cerretani D,
    3. Marsili S,
    4. Pozzessere D,
    5. Petrioli R,
    6. Messinese S,
    7. Sabatino M,
    8. Roviello F,
    9. Pinto E,
    10. Francini G,
    11. Giorgi G
    : Gemcitabine increases systemic 5-fluorouracil exposure in advanced cancer patients. Eur J Cancer 39: 1547-1551, 2003.
    OpenUrlCrossRefPubMed
  14. ↵
    1. Bitossi R,
    2. Sculli CM,
    3. Tampellini M,
    4. Alabiso I,
    5. Brizzi MP,
    6. Ferrero A,
    7. Ottone A,
    8. Bellini E,
    9. Gorzegno G,
    10. Berruti A,
    11. Dogliotti L
    : Gemcitabine and protracted 5-fluorouracil infusion as third-line chemotherapy in refractory colorectal cancer patients. Anticancer Res 28: 3055-3060, 2008.
    OpenUrlAbstract/FREE Full Text
  15. ↵
    1. Scheithauer W,
    2. Schull B,
    3. Ulrich-Pur H,
    4. Schmid K,
    5. Raderer M,
    6. Haider K,
    7. Kwasny W,
    8. Depisch D,
    9. Schneeweiss B,
    10. Lang F,
    11. Kornek GV
    : Biweekly high-dose gemcitabine alone or in combination with capecitabine in patients with metastatic pancreatic adenocarcinoma: a randomized phase II trial. Ann Oncol 14: 97-104, 2003.
    OpenUrlAbstract/FREE Full Text
  16. ↵
    1. Correale P,
    2. Messinese S,
    3. Marsili S,
    4. Ceciarini F,
    5. Pozzessere D,
    6. Petrioli R,
    7. Sabatino M,
    8. Cerretani D,
    9. Pellegrini M,
    10. Di Palma T,
    11. Neri A,
    12. Calvanese A,
    13. Pinto E,
    14. Giorgi G,
    15. Francini G
    : A novel biweekly pancreatic cancer treatment schedule with gemcitabine, 5-fluorouracil and folinic acid. Br J Cancer 89: 239-242, 2003.
    OpenUrlCrossRefPubMed
    1. Shepard RC,
    2. Levy DE,
    3. Berlin JD,
    4. Stuart K,
    5. Harris JE,
    6. Aviles V,
    7. Thomas JP,
    8. Benson AB III.
    : Phase II study of gemcitabine in combination with docetaxel in patients with advanced pancreatic carcinoma (E1298). A trial of the eastern cooperative oncology group. Oncology 66: 303-309, 2004.
    OpenUrlCrossRefPubMed
  17. ↵
    1. Tan BR,
    2. Brenner WS,
    3. Picus J,
    4. Marsh S,
    5. Gao F,
    6. Fournier C,
    7. Fracasso PM,
    8. James J,
    9. Yen-Revollo JL,
    10. McLeod HL
    : Phase I study of biweekly oxaliplatin, gemcitabine and capecitabine in patients with advanced upper gastrointestinal malignancies. Ann Oncol 19: 1742-1748, 2008.
    OpenUrlAbstract/FREE Full Text
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The Efficacy of Gemcitabine as Salvage Treatment in Patients with Refractory Advanced Colorectal Cancer (CRC): A Single Institution Experience
MUHAMMAD WASIF SAIF, KRISTIN KALEY, ROBIN PENNEY, SUSAN HOTCHKISS, KOSTAS N. SYRIGOS, ALEXIOS S. STRIMPAKOS
Anticancer Research Sep 2011, 31 (9) 2971-2974;

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The Efficacy of Gemcitabine as Salvage Treatment in Patients with Refractory Advanced Colorectal Cancer (CRC): A Single Institution Experience
MUHAMMAD WASIF SAIF, KRISTIN KALEY, ROBIN PENNEY, SUSAN HOTCHKISS, KOSTAS N. SYRIGOS, ALEXIOS S. STRIMPAKOS
Anticancer Research Sep 2011, 31 (9) 2971-2974;
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