News Release

Are capecitabine and irinotecan bevacizumab effective for colorectal cancer patients?

Peer-Reviewed Publication

World Journal of Gastroenterology

Over the last 20 years the overall survival of patients with advanced or metastatic colorectal cancer (mCRC) has improved with the use of combinations of new cytotoxic chemotherapy agents with monoclonal antibodies that are targeted to tumor expressed antigens. Most of this improvement has come from data obtained from clinical trials performed on patients recruited to specialized university-based hospitals which have experience in dealing with the delivery, and managing the toxic side effects of these agents. Furthermore patients recruited in these trials are often carefully selected, many having better prognosis than those seen routinely in community-based outpatient clinics where most of these patients are treated.

Capecitabine is an orally administered pro-drug which is activated in the body to 5-fluorouracil (5-FU) and kills dividing tumor cells by inhibiting the action of thymidylate synthase thus stopping DNA synthesis. It is often used for treating patients as it is easily administered compared with 5-FU, which is delivered to the patient intravenously. Irinotecan also kills tumor cells by preventing DNA synthesis through the inhibition of topoisomerase I an enzyme expressed in dividing cells. Finally bevacizumab is a monoclonal antibody that inhibits the activity of VEGF which when expressed aids the development of the blood supply to tumors, thus bevacizumab kills tumor cells by restricting their blood supply. In clinical trials the novel CAPIRI combination with and without bevacizumab has shown improved efficacy and tolerable toxicity in patients with advanced or mCRC compared with standard 5-FU-based chemotherapy regimens. However few studies have examined these regimens in a community-based hospital setting.

A research article to be published on January 28, 2009 in the World Journal of Gastroenterology has recently addressed this issue. The research team led by Dr Markus Moehler prospectively recruited 46 patients with advanced or mCRC who had not previously received chemotherapy from 9 community-based clinical outpatient clinics. The patients were consecutively recruited and were a typical representation of patients with advanced disease or mCRC that would be seen in this clinical setting. Patients received CAPIRI or CAPIRI plus bevacizumab at the discretion of the treating physician. The aim was to examine the response of the tumor to therapy and the toxicity profile of the treatment in the patient. Survival was also examined as a secondary aim. The team found that both regimens produced comparable tumor response rates, 29% for patients receiving CAPIRI and 35% for those receiving CAPIRI plus bevacizumab and overall survival was similar at 15 months and 24 months respectively. Toxicity was generally well tolerated with both regimens. These data were comparable to those published from clinical trials investigating CAPIRI and CAPIRI plus bevacizumab in mCRC.

Whilst the authors recognize that the numbers of patients studied were small, they feel that the results demonstrate the future promise of these specific drug combinations for the treatment of patients with advanced or mCRC in the community-based clinical outpatient setting. Although these departments are relatively inexperienced in the use of these agents and the treatment of their toxic side effects, they are often where new treatment regimens will be delivered to the patient.

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Reference: Moehler M, Sprinzl MF, Abdelfattah M, Schimanski CC, Adami B, Godderz W, Majer K, Flieger D, Teufel A, Siebler J, Hoehler T, Galle PR, Kanzler S. Capecitabine and irinotecan with and without bevacizumab for advanced colorectal cancer patients. World J Gastroenterol 2009; 15(4): 449-456 http://www.wjgnet.com/1007-9327/15/449.asp

Correspondence to: Markus Moehler, MD, 1st Medical Department, Johannes Gutenberg-University, Langenbeckstrasse 1, 55116 Mainz, Germany. moehler@mail.uni-mainz.de

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

About The WJG Press

The WJG Press mainly publishes World Journal of Gastroenterology.


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