위장관 ; 진행성 위암 환자에서 1차 치료 실패 후 2차 요법으로 FOLFIRI 병합화학약물 치료의 효과와 안정성

권혜정 ( Hye Jung Kwon ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ),문원 ( Won Moon ),김성은 ( Sung Eun Kim ),이혜원 ( Hae Won Lee ),최윤정 ( Youn Jung Choi ),김재현 ( Jae Hyun Kim ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.1

목적: 수술적 절제가 불가능한 진행성 위암으로 진단된 환자에서 1차 항암요법으로 FOLFOX-4를 시행한 이후 실패하여 2차항암요법으로 irinotecan을 기반으로 한 FOLFIRI 요법을 시행한 환자에서의 효용성과 안정성에 대해 알아보고자 하였다.대상 및 방법: 2005년 9월부터 2012년 2월까지 고신대학교복음병원에 방문하여 절제가 불가능한 진행성 위암으로 진단받고, 1차 항암요법으로 FOLFOX-4를 시행한 이후 치료에 실패하여 2차 항암요법으로 FOLFIRI 요법을 시행한 52명의 환자를 대상으로 후향적으로 시행하였다. 반응은 WHO 기준에근거하여 항암요법 매 3주기마다 시행하였으며, NCI 독성 기준(version 3.0)에 따라 항암요법에 대한 독성을 평가하였다.결과: 대상 환자의 평균연령은 57세였고, 총 생존기간은 7.8개월, 반응 지속기간은 5개월로 조사되었다. 완전 관해는 없었고, 부분 관해가 9예(17.3%), 불변이 30예(57.7%), 진행이 13예(25.0%)였다. 반응률은 17.3%, 질병통제율은 75.0%였다. 전체 항암 요법 345회 중 용량 감량은 114회에서 시행하였다. 독성이나 부작용으로 인한 사망은 이번 연구에서는 관찰되지 않았다. 가장 흔한 부작용은 빈혈이었다(319회, 92.5%). 독성으로 인해 약제를 변경한 경우는 없었다. 전이의 개수가 적을수록, 혈청 CA 19-9의 수치가 34 U/mL 이하인 경우, 2차항암요법 첫 3주기 시행 이후의 반응이 좋았던 경우에서 총생존기간과 반응 지속기간의 연장을 보였다. 결론: 이번 연구를 통해 진행성 위암에서 2차 항암요법으로 FOLFIRI 요법은 비교적 높은 반응률을 보이며, 부작용이 적어 효과적이면서도 안전한 치료법으로 고려해 볼 수 있겠다. 향후 2차항암치료의 정립을 위해 본 연구가 도움이 될 것으로 생각된다. Background/Aims: The purpose of this study was to investigate the efficacy and safety of irinotecan based FOLFIRI chemotherapy as a second-line treatment after failure of FOLFOX-4 chemotherapy in patients with advanced gastric cancer. Methods: Fifty-two patients who were pathologically diagnosed with unresectable gastric cancer and received FOLFIRI chemotherapy after failure of FOLFOX-4 chemotherapy between September 2005 and February 2012 were enrolled in this study. Data were collected by retrospectively reviewing the medical records. The response to chemotherapy was assessed every 3 cycles by World Health Organization criteria and long term survival was analyzed. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institution (NCI) toxicity criteria version 3.0. Results: Median age of the patients was 57 years. Median overall survival (OS) and time to progression (TTP) were 7.8 and 5 months, respectively. The number of patients showing complete remission, partial remission, stable disease, and progressive disease were 0 (0.0%), 9 (17.3%), 30 (57.7%), and 13 (25.0%), respectively. The overall response rate was 17.3%. During a total of 345 cycles, anemia worse than NCI toxicity grade 3 occurred in 2.9%, leukopenia in 20.3%, neutropenia in 12.2%, and thrombocytopenia in 1.5%. Patients with less organ involvement by metastasis, less than 34 U/mL of CA 19-9 and good responsiveness to third cycle of second line chemotherapy were associated with longer OS and TTP. Conclusions: FOLFIRI chemotherapy has a modest efficacy with acceptable toxicities in patients with advanced gastric cancer as a second-line treatment. Further well-controlled studies are needed to elucidate the efficacy of FOLFIRI chemotherapy as second-line treatment in patients with advanced stomach cancer. (Korean J Gastroenterol 2015;66:10-16)

진행성 대장암 환자에서 FOLFOX4 복합화학약물 치료의 실패 후 2차 요법으로 FOLFIRI 복합화학약물 치료의 효과와 안전성

김재현 ( Jae Hyun Kim ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),문원 ( Won Moon ),김성은 ( Sung Eun Kim ),구기환 ( Ki Hwan Ku ),송성은 ( Sung Eun Song ),김제훈 ( Je Hun Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1

Background/Aims: The incidence of colorectal cancer has been increasing every year in Korea. Irinotecan- or oxaliplatin-based regimens including biologic agents are known to be effective in patients with advanced colorectal cancer. But in practice, FOLFOX (combination of oxaliplatin, 5-fluorouracil, and leucovorin) or FOLFIRI (combination of irinotecan, 5-fluorouracil, and leucovorin) regimens without biologic agents are more commonly used in Korea due to of the high costs of biologic agents. The aim of this study was to evaluate the efficacy and toxicity of FOLFIRI following FOLFOX4 in patients with advanced colorectal cancer. Methods: A total of 54 patients with advanced colorectal cancer who were treated between May 2005 and May 2013 with FOLFOX4 as first-line chemotherapy and with FOLFIRI as second-line chemotherapy at Kosin University Gospel Hospital (Busan, Korea) were reviewed retrospectively. Results: A total of 54 patients received second-line FOLFIRI chemotherapy. Five patients (9.3%) had a partial response, 29 patients (53.7%) had a stable disease. The median overall survival was 8.90 months and the median time to progression was 4.33 months. Toxicities were tolerable. Conclusions: In a Korean population, FOLFIRI as second-line chemotherapy is effective and well tolerated in patients with advanced colorectal cancer after failure of FOLFOX4. Although the efficacy of FOLFIRI in this study was lower than that of second-line FOLFIRI with biologic agents, these results can help in the formulation of a treatment strategy for financially troubled patients. (Korean J Gastroenterol 2014;63:18-24)

Oxaliplatin, 5-Fluorouracil and Leucovorin (FOLFOX-4) as First Line Chemotherapy in Elderly Patients with Advanced Gastric Cancer

Haghighi, Shirin,Kasbkar, Hadi,Esmaeilpour, Keihan,Yasaei, Mehrdad Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.7

Background: Gastric cancer is considered the fourth most common cancer and second most common cause of cancer-related mortalities worldwide. Gastric cancer develops more frequently among elderly. The oxaliplatin/5FU/leucovorin (FOLFOX) regimen has shown a notable activity against gastric cancer. Aim: To evaluate the responses and complications of FOLFOX-4 regimen as first line chemotherapy in elderly patients with advanced gastric cancer. Materials and Methods: From October 2014 to November 2015, a total of 21 patients with metastatic or local AGC (advanced gastric cancer) were analyzed. All patients were administered a FOLFOX-4 regimen consisting of a 2h infusion of oxaliplatin $85mg/m^2$ (day 1), continuous infusion of $1000mg/m^2$ 5-Fu in 24h., and leucovorin $200mg/m^2$ in 2h infusion as a first-line chemotherapy. Results: A total of 18 patients were assessable for efficacy and toxicity. One of 18 patients achieved a complete response, and 12 had partial responses, giving an overall response rate of 72.6%. Three (16%) patients demonstrated stable disease and 2 (12%) progression. The median progression free survival was 7.3 months, and the median overall survival was 11.9 months. One patient had grade 3 neuropathy. No other grade 3 or 4 NCI-CTC were seen. Conclusions: The FOLFOX-4 regimen used in our study was both active and acceptable for AGC in elderly patients as neoadjuvant and main therapy.

Adjuvant Chemotherapy Using the FOLFOX Regimen in Colon Cancer

전형준,우진희,이학윤,박기재,최홍조 대한대장항문학회 2011 Annals of Coloproctolgy Vol.27 No.3

Purpose: Great progress has been made in the adjuvant treatment of colon cancer. The aim of this study was to evaluate the efficacy of postoperative adjuvant chemotherapy using the FOLFOX regimen in patients with stage III and high-risk stage II colon cancer. Methods: Eighty-two patients who underwent a potentially curative resection for stage III or high-risk stage II colon cancer were enrolled in this retrospective study. They received FOLFOX4 or modified FOLFOX6. The primary endpoint was disease-free survival. Results: During the median follow-up of 37 months (range, 21 to 61 months), 14 patients experienced disease relapse. The disease-free survival rate at 3 years was 82.9%: 84.6% for stage II and 82.6% for stage III. At the time of the analysis, 8 patients were dead from recurrence. The probability of overall survival at 5 years was 74.5%: 90% for stage II and 74.6% for stage III. Grade 3 or 4 hematologic adverse events included neutropenia (40.2%), anemia (2.4%), and thrombocytopenia (1.2%). Gastrointestinal toxicities included grade 3 or 4 nausea (4.9%) and stomatitis (2.4%). Peripheral sensory neuropathy was observed in 81.7% of the patients during treatment. Of the 11 patients (13.4%) who had grade 3 peripheral sensory neuropathy during treatment, grade 3 symptoms were persistent in 3 patients with gait disturbance at the time of analysis. No treatment-related deaths were recorded. Conclusion: Postoperative chemotherapy using the FOLFOX regimen, oxaliplatin in combination with 5-fluorouracil and leucovorin, is effective and tolerable in patients with stage III and high-risk stage II colon cancer.

FOLFOX 항암화학요법을 받는 대상자의 저림감과 일상생활 어려움

이혜선(Lee Hye Seon),김명희(Kim Myung Hee),강은희(Kang Eun Hee) 한국재활간호학회 2010 재활간호학회지 Vol.13 No.2

Purpose: This study was to investigate difficulties in daily activities and tingling from patients having treatment of FOLFOX chemotherapy after colon resection. Method: This study included 103 patients hospitalized for FOLFOX chemotherapy in one of the university affiliated hospital from August 1, 2008 through September 30, 2009. Data were collected using the questionnaire comprised general symptoms, tingling, difficulties in daily activities and coping behavior. Using the SPSS 14.0 program, data analytic methods include Chi-Square test, ANOYA, Scheffe's test. Results: The tingling sensation occurred in hands, feet, mouth, throat. Contacts with cold objects and the number of chemotherapy cycle worsen tingling sensation. Patients experienced difficulties in daily activities such as personal hygiene, kitchen work, eating cold food, sleeping cold, using fine motors like button up, writing, or using knife. The coping behavior included drinking warm water, sleeping warm, using gloves and socks, wearing comfortable shoes, massaging hands and getting help from supporters. Conclusion: An educational guideline for promoting coping behavior to relieve tingling sensation and difficulty in daily living in patients with FOLFOX chemotherapy is needed.

Protective effect of Korean red ginseng on oxaliplatin-mediated splenomegaly in colon cancer

Jeonghyun Kang,Joon Seong Park,Sung Gwe Ahn,Jin Hong Lim,Seung Hyuk Baik,Dong Sup Yoon,Kang Young Lee,Joon Jeong 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.3

Purpose: This study investigated how adding Korean red ginseng extract (KRG) to folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy affected the rate of splenomegaly in colon cancer. Methods: This retrospective study analyzed 42 patients who were randomly assigned to receive a FOLFOX regimen with or without KRG. Spleen volume change was assessed by computed tomography scans measured before surgery (presurgery volume) and 3 weeks after cessation of the 12th cycle of FOLFOX (postchemotherapy volume). Results: All patients showed increased spleen volume. No difference was observed in median presurgery and postchemotherapy volume between the KRG and control groups. However, a ratio defined as postchemotherapy volume divided by presurgery volume was significantly lower in the KRG group than the control group (median, 1.38 [range, 1.0–2.8] in KRG group vs. median, 1.89 [range, 1.1–3.0] in control group, P = 0.028). When splenomegaly was defined as a >61% increase in spleen volume, the rate of splenomegaly was significantly lower in the KRG group than the control group (28.6% vs. 61.9%, P = 0.03). KRG consumption was inversely associated with developing splenomegaly in multivariate analysis. Conclusion: Adding KRG during FOLFOX chemotherapy for colon cancer might protect against oxaliplatin-induced splenomegaly. The protective effect of Korean red ginseng should be investigated with further research.

Protective effect of Korean red ginseng on oxaliplatin-mediated splenomegaly in colon cancer

Kang, Jeonghyun,Park, Joon Seong,Ahn, Sung Gwe,Lim, Jin Hong,Baik, Seung Hyuk,Yoon, Dong Sup,Lee, Kang Young,Jeong, Joon The Korean Surgical Society 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.3

<P><B>Purpose</B></P><P>This study investigated how adding Korean red ginseng extract (KRG) to folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy affected the rate of splenomegaly in colon cancer.</P><P><B>Methods</B></P><P>This retrospective study analyzed 42 patients who were randomly assigned to receive a FOLFOX regimen with or without KRG. Spleen volume change was assessed by computed tomography scans measured before surgery (presurgery volume) and 3 weeks after cessation of the 12th cycle of FOLFOX (postchemotherapy volume).</P><P><B>Results</B></P><P>All patients showed increased spleen volume. No difference was observed in median presurgery and postchemotherapy volume between the KRG and control groups. However, a ratio defined as postchemotherapy volume divided by presurgery volume was significantly lower in the KRG group than the control group (median, 1.38 [range, 1.0–2.8] in KRG group vs. median, 1.89 [range, 1.1–3.0] in control group, P = 0.028). When splenomegaly was defined as a >61% increase in spleen volume, the rate of splenomegaly was significantly lower in the KRG group than the control group (28.6% <I>vs</I>. 61.9%, P = 0.03). KRG consumption was inversely associated with developing splenomegaly in multivariate analysis.</P><P><B>Conclusion</B></P><P>Adding KRG during FOLFOX chemotherapy for colon cancer might protect against oxaliplatin-induced splenomegaly. The protective effect of Korean red ginseng should be investigated with further research.</P>

Analysis of reduced-dose administration of oxaliplatin as adjuvant FOLFOX chemotherapy for colorectal cancer

Dawon Park,Se-Jin Baek,Jung-Myun Kwak,Jin Kim,Seon-Hahn Kim 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.94 No.4

Purpose: An oxaliplatin-based regimen is the most common adjuvant chemotherapy for patients with stage II/III colorectal cancer, but many patients experience dose reduction or early termination of chemotherapy due to side effects. We conducted this study to verify the range of reduction with oncologic safety. Methods: Patients with stage II/III colorectal cancer who received adjuvant FOLFOX chemotherapy were enrolled in this study. The total amount of oxaliplatin administered per patient was calculated as a percentile based on 12 cycles of fulldose FOLFOX as a standard dose. The cutoff values showing significant differences in survival were calculated, and the clinicopathologic outcomes of patient groups classified by the value were compared. Results: Among a total of 611 patients, there were 107 stage II patients, and 504 stage III patients. At 60% of the standard dose of oxaliplatin, the patients in the dose reduction group were older (62 years vs. 58 years, P = 0.003), had lower body mass index (BMI) (23.1 kg/m2 vs. 24.0 kg/m2, P = 0.005), and were more exposed to neoadjuvant treatment (18.0% vs. 9.1%, P = 0.003) in comparison to the standard group. At 60% of the standard dose, there were no significant differences in 5-year disease-free survival (DFS) and overall survival (OS) between the 2 groups (5-year DFS: 73.5% vs. 74.2%, P = 0.519; 5-year OS: 71.9% vs. 81.5%, P = 0.256, respectively). Conclusion: Patients with old age, low BMI, and more frequent exposure to neoadjuvant treatment tended to show lower compliance with chemotherapy. More than 60% dose should be administered to patients with stage II/III colorectal cancer as adjuvant chemotherapy to achieve acceptable oncologic outcomes.

Quality of life changes during adjuvant chemotherapy in patients with colon cancer

Seo Hee Lee(이서희),Taek-Gu Lee(이택구),Moo Jun Baek(백무준),Jang Jin Kim(김장진),Sung-Su Park(박성수),Sang-Jeon Lee(이상전) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.1