The Non-randomized Controlled Trial For The Unresectable Metastatic Colorectal Cancer First-line Treatment Is FOLFIRI And FOLFOX

Purpose: This research regard the unresectable metastatic colorectal cancer patients which accept the first-line chemotherapy of FOLFOX or FOLFIRI as study object,comparing curative effect,Progression-free Survival(PFS) and the occurrence of toxicity different between two regimens,then stand in groups according to the K-ras gene status,targeted therapy, primary tumor site, whether the primary tumor excised, metastatic area, number of metastases, response evaluation,initial tumor markers, comparing the Progression-free Survival(PFS) different between the two regimens in the different groups,thus explore the influential factor of curative effect,and search the clinical advantage groups for each regimen.Materials and Methods: Collecting 253 patients with unresectable m CRC which referred for treatment to the Oncology at Fujian Medical University Union Hospital from August 2011 to August 2014. Then nonrandom divides into FOLFIRI and FOLFOX two groups,one group patients had accepted FOLFIRI of combined chemotherapy as first-line treatment,another had accepted FOLFIRI of combined chemotherapy as first-line treatment, evaluate the curative effect each three cycles until achieved Progressive Disease(PD) or appear intolerable toxicity,then count the time of PFS and evaluate the short term efficacy. Comparing the curative effect, PFS and the occurrence of toxicity different between two regimens,then stand in groups according to the K-ras gene status,targeted therapy, primary tumor site, whether the primary tumor excised, metastatic area, number of organ metastases, response evaluation, initial tumor markers, comparing the PFS different between the two regimens in the different groups.Results: 92 patients had accepted FOLFIRI of combined chemotherapy as first-line treatment,161 had accepted FOLFIRI of combined chemotherapy as first-line treatment,the baseline characteristics was equal between two groups,which was statistically significant.The curative effect(38.0% vs 39.8%,P=0.789) and median PFS(7.0m vs 7.1m,95% CI 5.9-8.1m vs 6.0-8.1m,P=0.516)between FOLFIRI and FOLFOX was statistically insignificant. In the toxicity,FOLFIR was statistically significant different compared with FOLFOX in delayed diarrhea(12.0% vs 0.0%,P=0.00),cholinergic syndrome(10.9% vs 0.0%,P=0.00) and alopecia(33.7% vs 14.9%,P=0.00).FOLFOX was statistically significant different compared with FOLFIRI in neurotoxicity(56.5% vs 10.7%,P=0.00),thrombocytopenia(50.3% vs 3.3%,P=0.00) and allergic reactions of oxaliplatin(9.3% vs 0.0%,P=0.03).The median PFS between FOLFIRI and FOLFOX was statistically insignificant In the subgroup.Conclusion: In the unresectable metastatic colorectal cancer patients which accept the first-line chemotherapy,the curative effect and median PFS between FOLFIRI and FOLFOX was statistically insignificant, delayed diarrhea,cholinergic syndrome and alopecia were significantly more frequent with FOLFOX than with FOLFIRI was, neurotoxicity,thrombocytopenia and allergic reactions of oxaliplatin were significantly more frequent with FOLFIRI than with FOLFOX was. Although the median PFS between FOLFIRI and FOLFOX in the subgroup was statistically insignificant, but the median PFS between FOLFIRI and FOLFOX in the part of subgroup have a separation trends, When the initial tumor markers is high,FOLFIRI have a tendency to extend than FOLFOX is;When the response evaluation is SD,K-ras gene is wide-type,combined C225 targeted therapy、initial CA199 was normal, FOLFOX have a tendency to extend than FOLFIRI is,which can provide new ideas for us in the furtherstudy and the choice of clinical medicine for the clinical advantage...