Published online in advance in Lancet Oncology this week, researchers in France present results from a phase III study of sequential versus combination chemotherapy for the treatment of advanced colorectal cancer. The team randomly assigned 410 patients with advanced, measurable, non-resectable colorectal cancer to receive either first-line treatment with bolus and infusional fluorouracil plus leucovorin, second-line LV5FU2 plus oxaliplatin, and third-line LV5FU2 plus irinotecan, or the first-line combination treatment FOLFOX6 and second-line combination FOLFIRI. During the study, 79 percent of the patients in both groups died, but all six of the study's deaths caused by toxic side effects from the treatment occurred solely in the combination therapy group, the authors write. The sequential therapy group had significantly fewer hematological adverse events and non-hematological adverse events, and median progression-free survival after two lines of treatment was about the same for both groups. "Upfront combination chemotherapy is more toxic and is not more effective than the sequential use of the same cytotoxic drugs in patients with advanced, non-resectable colorectal cancer," the authors write.
Also in Lancet Oncology this week, a group of Scandinavian investigators examines long-term quality-of-life outcomes for prostate cancer patients after radical prostatectomy versus watchful waiting. The team analyzed data from a group of men randomly assigned to radical prostatectomy or watchful waiting from 1989 to 1999, and additional controls, and found that high self-assessed quality of life was reported by 35 percent of the men in the radical prostatectomy group, 34 percent of the men in the watchful waiting group, and 45 percent of the controls. Prevalence of erectile dysfunction was similar in both patient groups, though lower in controls. Prevalence of urinary leakage was 41 percent in the prostatectomy group compared with 11 percent and 3 percent in the waiting group and control group, respectively.
Finally in Lancet Oncology this week, an international group of researchers present a study on the use of nilotinib versus imatinib for patients with newly diagnosed chronic phase, Philadelphia chromosome-positive, chronic myeloid leukemia. The team randomly assigned CML patients to receive either nilotinib at 300 milligrams twice a day, nilotinib at 400 milligrams twice a day, or imatinib at 400 milligrams once a day. Twenty-four months after the start of treatment, significantly more patients had a major molecular resposen with nilotinib than with imatinib, and significantly more patients in the nilotinib groups achieved a complete molecular response than those in the imatinib group. "Nilotinib continues to show better efficacy than imatinib for the treatment of patients with newly diagnosed CML in chronic phase. These results support nilotinib as a first-line treatment option for patients with newly diagnosed disease," the authors write.