An AXEPTional option.
The Study: FOLFIXIRIB has been making headlines as the new best option for metastatic colon cancer, but there’s a whole lotta drugs in that acronym meaning lots of heavy treatment. Capecitabine (aka Xeloda) + irinotecan, on the other hand, is notably more convenient. So the Asian phase 3 non-inferiority AXEPT trial compared the two regimens head-to-head. Side note: Together the modified combo of Xeloda and irinotecan goes by the nickname mXELIRI because what respectable couple doesn’t have a catchy portmanteau? The trial randomized 650 patients with metastatic colorectal cancer previously treated (with oxaliplatin in >97%) to FOLFIRI versus mXELIRI with a primary endpoint of overall survival. FOLFIRI involved intravenous infusions of 5-FU, leucovorin and irinotecan (3.5 hours) followed by a 46-hour continuous infusion of 5-FU every two weeks, while mXELIRI was simply an infusion of irinotecan (1.5 hour) every three weeks with a twice daily Xeloda pill. All patients were allowed to get bevacizumab, and 83-84% in each arm did. Median overall survival was 15 months with FOLFIRI and 17 months with mXELIRI, easily meeting its non-inferiority threshold. What’s more, the grade 3-4 toxicity rate was lower with mXELIRI (72→54%) primarily due to less neutropenia.
Bottom Line: mXELIRI is an effective, well tolerated, more convenient and just really all-around exceptional alternative to FOLFIRI as a standard systemic treatment option for metastatic colorectal cancer. | Xu, Lancet Oncol 2018