Folfiri is less effective than folfox???

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mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Folfiri is less effective than folfox???

Postby mpbser » Sat Apr 06, 2019 1:07 pm

I was reading this journal article and stumbled upon something a bit worrisome as my husband is scheduled to start Folfiri in nine days:

"the FOLFIRI regimen (folinic acid, 5-FU, and irinotecan) is less efficient than the FOLFOX regimen (folinic acid, 5-FU, and oxaliplatin) for the treatment of colorectal cancer (Nelson et al., 2011)"

Ugh!

http://dx.doi.org/10.1016/j.ccell.2015.10.012
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

Pyro
Posts: 305
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Folfiri is less effective than folfox???

Postby Pyro » Sat Apr 06, 2019 6:59 pm

Everyone is different, no two respond th same. However, I found FOLFURI was easier than FOLFOX, hope it helps.
Aug 2015- Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail
Jun 2019 - FOLFURI
Aug 2019 - No more, quality time!

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Folfiri is less effective than folfox???

Postby Rock_Robster » Sat Apr 06, 2019 10:34 pm

Careful with this quote... it references a study comparing the *cost efficiency* of the two treatments, with a very small sample size (around 40 people in one group). There’s lots of bigger studies comparing FOLFOX and FOLFIRI effectiveness (not efficiency), and as Pyro says - everyone is different and responds differently!

Both are considered very effective treatments however (and FOLFIRI can generally be tolerated for much longer).
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Folfiri is less effective than folfox???

Postby mpbser » Sun Apr 07, 2019 6:18 am

The basis of the statement was the article: A comparison of mortality and costs associated with FOLFOX versus FOLFIRI in stage IV colorectal cancer. Nelson MA1, Shetty S, Kulakodlu M, Harley C, Seal B. So, yes, the study compared costs along with mortality. I don't think that changes the veracity of the statement: the FOLFIRI regimen (folinic acid, 5-FU, and irinotecan) is less efficient than the FOLFOX regimen (folinic acid, 5-FU, and oxaliplatin) for the treatment of colorectal cancer but I do now take note of the use of "efficient" instead of "effective." Still, the Nelson article data included, "Death occurred among five (12%) FOLFOX and 42 (53%) FOLFIRI patients." https://www.ncbi.nlm.nih.gov/pubmed/213 ... t=Abstract

I searched some more since this was a small sample size. Thankfully, it does seem that the data supports the conclusion that the two have equivalent results in terms of survival: "No survival difference was detected for the 2 groups." https://www.ncbi.nlm.nih.gov/pubmed/30878317

Good.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Folfiri is less effective than folfox???

Postby Rock_Robster » Sun Apr 07, 2019 7:00 am

Good job mpbser - sounds like a reasonable (and reassuring) conclusion!
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

zephyr
Posts: 363
Joined: Thu Aug 18, 2016 7:31 am

Re: Folfiri is less effective than folfox???

Postby zephyr » Sun Apr 07, 2019 1:31 pm

mpbser wrote:The basis of the statement was the article: A comparison of mortality and costs associated with FOLFOX versus FOLFIRI in stage IV colorectal cancer. Nelson MA1, Shetty S, Kulakodlu M, Harley C, Seal B. So, yes, the study compared costs along with mortality. I don't think that changes the veracity of the statement: the FOLFIRI regimen (folinic acid, 5-FU, and irinotecan) is less efficient than the FOLFOX regimen (folinic acid, 5-FU, and oxaliplatin) for the treatment of colorectal cancer but I do now take note of the use of "efficient" instead of "effective." Still, the Nelson article data included, "Death occurred among five (12%) FOLFOX and 42 (53%) FOLFIRI patients." https://www.ncbi.nlm.nih.gov/pubmed/213 ... t=Abstract

I searched some more since this was a small sample size. Thankfully, it does seem that the data supports the conclusion that the two have equivalent results in terms of survival: "No survival difference was detected for the 2 groups." https://www.ncbi.nlm.nih.gov/pubmed/30878317

Good.


Thanks for taking the time to drill down on this and provide a clearer picture. Good catch on "efficient" vs. "effective".
Nov-2009 Early stage CRC, routine colonoscopy
2010-2014 F/U colonoscopies, all clear
Jun-2016 CRC during F/U colonoscopy, surgery, Stage 4, KRAS, MSS
Aug-2016-May-2018 Folfox, 5FU, Folfiri & Avastin
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Mar-2021 Forfiri/Avastin
Mar-2022 Ablation & Thoracotomy
Feb-2023 Folfiri & Avastin
Nov-2023 Xeloda & Avastin


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