5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) as a third-line chemotherapy treatment in metastatic gastric cancer, after failure of fluoropyrimidine, platinum, anthracycline, and taxane

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Erdem G. U., Bozkaya Y., Ozdemir N. Y., Demirci N. S., Yazici O., Zengin N.

BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES, vol.18, no.2, pp.170-177, 2018 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 18 Issue: 2
  • Publication Date: 2018
  • Doi Number: 10.17305/bjbms.2017.2258
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.170-177
  • Keywords: Chemotherapy, metastatic gastric cancer, modified FOLFIRI, third-line therapy, prognosis, 5-fluorouracil, leucovorin, irinotecan, PROGNOSTIC-FACTOR ANALYSIS, RANDOMIZED PHASE-III, 2ND-LINE CHEMOTHERAPY, SALVAGE CHEMOTHERAPY, PLUS 5-FLUOROURACIL, SUPPORTIVE CARE, OUTCOMES, PACLITAXEL, DOCETAXEL, FLUOROURACIL
  • Gazi University Affiliated: No


Studies on the effects of third-line chemotherapy (CT) in advanced gastric cancer (GC) patients are still scarce. The aim of this study was to evaluate the efficacy and safety of the modified 5-fluorouracil, leucovorin, and irinotecan (mFOLFIRI) regimen as a third-line CT in metastatic GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane. After failure of first-and second-line therapies, 42 patients received third-line FOLFIRI (180 mg/m(2) irinotecan and 400 mg/m(2) leucovorin administered concomitantly as a 90-minute intravenous (IV) infusion on day 1, followed by a 400 mg/m(2) 5-fluorouracil IV bolus then 2600 mg/m(2) continuous infusion over 46 hours), between January 2009 and December 2015. FOLFIRI was administered for a median of 6 cycles (range 4-12 cycles). Eight patients achieved partial response, while 13 patients showed stable disease, resulting in the overall response rate (ORR) of 19% and disease control rate (DCR) of 50%. The most frequent grade 3-4 hematological and non-hematological toxicities were neutropenia (14.2%) and diarrhea (7.1%). The median progression-free survival (PFS) and overall survival (OS) from the start of third-line CT were 3.8 months (95% confidence interval [CI], 3.0-4.5) and 6.8 months (95% CI, 5.6-7.9), respectively. According to the multivariate analysis, two factors were independently predictive of the poor OS: > 2 regions of metastasis (relative risk [RR], 2.6; 95% CI, 1.3-5.4) and a high level of carcinoembryonic antigen [CEA] (RR, 3.4; 95% CI, 1.6-7.4). In conclusion, FOLFIRI was well tolerated as third-line CT and showed promising PFS and OS in advanced GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane.