Modification of Leucovorin Dose Within a Simplified FOLFOX Regimen Improves Tolerability Without Compromising Efficacy

BackgroundThis analysis assesses the efficacy and safety of a modified FOLFOX (oxaliplatin/leucovorin [LV]/5-fluorouracil [5-FU]) regimen given with a low dose of LV.Patients and MethodsForty patients with previously untreated metastatic colorectal cancer were enrolled to receive every-2-week cycles of oxaliplatin 100 mg/m2 intravenously administered over 2 hours concurrently with LV 20 mg/m2 bolus and 5-FU 400 mg/m2 bolus, followed by a 46-hour infusion of 5-FU 2.4 g/m2.ResultsThirty-nine patients received ≥ 1 oxaliplatin dose and a median of 10 treatment cycles (range, 1–13 cycles). Thirteen patients (34%) experienced grade 3/4 neutropenia, whereas 21% of patients experienced grade 3 neurotoxicity. Of 37 eligible patients, complete or partial responses were observed in 18 patients (49% [95% confidence interval (CI), 32%–66%]). The median progressionfree survival was 6.2 months (95% CI, 5.5–8.7 months) with a median overall survival of 14.2 months (95% CI, 10–20.5 months).ConclusionA modified schedule of FOLFOX using a lower than standard dose of LV provides good response and survival results with excellent safety. A comparison with a previous study undertaken in the same centers using identical inclusion/exclusion criteria but using higher doses of LV suggests that reducing the dose of LV improves safety without compromising efficacy.