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Boosted Capecitabine Shows Promise in Metastatic Colorectal Cancer: Presented at ECCO

By Michael Smith

COPENHAGEN, DENMARK -- September 24, 2003 -- The addition of a booster drug improves the efficacy of capecitabine in patients with metastatic colorectal cancer, while making little change to the type and number of side effects, British and Australian researchers report.

The new findings on capecitabine, an antimetabolite drug, were presented here September 22^nd here at ECCO 12: The European Cancer Conference.

"[Capecitabine] is well tolerated, easy to give in an outpatient setting, with very good efficacy in terms of objective response, and [is] quite promising [in terms of] failure free-survival and overall survival," said Sheila Rao, MD, Royal Marsden Hospital, London, United Kingdom.

Capecitabine was coupled with mitomycin M because capecitabine is converted to its active form by the enzyme thymidine phosphorylase (TP), which is boosted by mitomycin M within the tumor. The combination effectively increases the power of capecitabine to interfere with tumour growth, Dr. Rao said.

Dr. Rao and her colleagues presented 2 studies. The first study assessed the combination as a first-line therapy in patients with metastatic colorectal cancer. The second study used the combination as a third-line therapy for patients who were resistant to 5-fluorouracil and irinotecan, 2 of the other front-line drugs.

Patients in both studies were given 2,500 mg/mm² of oral capecitabine every day for 14 days, followed by a week of rest and 7 mg/mm² of mitomycin intravenously every 6 weeks before the capecitabine. No grade 4 and a few grade 3 adverse events were seen in either study, Dr. Rao said.

In the first-line study of 64 patients, the median overall survival was 14.7 months, and the median disease-free survival was 7.2 months. "Admittedly with very small numbers," Dr. Rao said.

In the third-line study of 31 patients, median overall survival was 8.44 months and median disease-free survival was 5.75 months.

The drug combination still needs more testing, Dr. Rao said, but it appears to be "on a par with many of the combination regimens [now in use]," and appears to be better than therapy with single-agent 5 fluorouracil.


[Study title: Capecitabine and Mitomycin C (MMC) Is an Active Well-Tolerated Regimen as First-Line Treatment for Metastatic Colorectal Cancer (MCRC). Abstract 285;

Study title: Promising Activity with Capecitabine and Mitomycin C (MMC) as Third-Line Therapy for Patients with Metastatic Colorectal Cancer (MCRC) Resistant to Fluorouracil (5-FU) and Irinotecan: Results of a Phase II Study. Abstract 286]

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