Systemic treatment of advanced colorectal cancer: FOLFOX or XELOX?

Abstract

Chemotherapy with oxaliplatin and fluoropirymidines is one of the standard regimens for treatment of advanced colorectal cancer in the first-line setting. Capecitabine is an oral fluoropirymidine showing equal efficacy in monotherapy of colorectal cancer as intravenous 5-fluorouracil. Recently, the results of few randomized phase III trials comparing the efficacy and tolerability of XELOX (capecitabine + oxaliplatin) vs. FOLFOX/FUOX/FUFOX (infusional 5-flurorouracil + oxaliplatin) regimens in the first-line treatment of advanced colorectal cancer have been published. The results of few studies indicate marginally inferior activity of XELOX, whereas preliminary data from other two studies prove that XELOX and FOLFOX have equal efficacy. After adding bevacizumab, the activity of the two regimens remains comparable, however it seems that bevacizumab increases the activity of XELOX regimen more compared to FOLFOX, and in one observational study progression free survival in XELOX + bevacizumab arm was slightly longer. Toxicity of these two regimens does not differ significantly. Based on available data, it seems that FOLFOX remains the standard treatment regimen for advanced colorectal cancer in the first-line setting.