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Adequate SIRT activity dose is as important as adequate chemotherapy dose

2017; Elsevier BV; Volume: 18; Issue: 11 Linguagem: Inglês

10.1016/s1470-2045(17)30811-2

1474-5488

Arthur J. A. T. Braat, S. Cheenu Kappadath, Rutger C. G. Bruijnen, Andor F. van den Hoven, Armeen Mahvash, Hugo W. A. M. de Jong, Marnix G. E. H. Lam,

Colorectal Cancer Treatments and Studies

In their Article, Harpreet Wasan and colleagues 1 Wasan HS Gibbs P Sharma NK et al. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials. Lancet Oncol. 2017; 18: 1159-1171 Summary Full Text Full Text PDF PubMed Scopus (203) Google Scholar reported a combined analysis of three prospective randomised controlled trials (SIRFLOX, FOXFIRE, and FOXFIRE-Global) that compared a regimen of first-line leucovorin, fluorouracil, and oxaliplatin (FOLFOX) plus selective internal radiotherapy (SIRT) with yttrium-90 resin microspheres with FOLFOX alone in patients with colorectal cancer with liver metastases. They found no survival benefit for the FOLFOX plus SIRT group (median overall survival 22·6 months [95% CI 21·0–24·5] with FOLFOX plus SIRT vs 23·3 months [21·8–24·7] with FOLFOX alone; p=0·61). 1 Wasan HS Gibbs P Sharma NK et al. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials. Lancet Oncol. 2017; 18: 1159-1171 Summary Full Text Full Text PDF PubMed Scopus (203) Google Scholar However, we believe that an appropriate interpretation of the study data will require critical review, especially the technical details of the studied medical device (ie, yttrium-90 resin microspheres). First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trialsAddition of SIRT to first-line FOLFOX chemotherapy for patients with liver-only and liver-dominant metastatic colorectal cancer did not improve overall survival compared with that for FOLFOX alone. Therefore, early use of SIRT in combination with chemotherapy in unselected patients with metastatic colorectal cancer cannot be recommended. To further define the role of SIRT in metastatic colorectal cancer, careful patient selection and studies investigating the role of SIRT as consolidation therapy after chemotherapy are needed. Full-Text PDF Open AccessAdequate SIRT activity dose is as important as adequate chemotherapy dose – Authors' replyThe FOXFIRE, SIRFLOX, and FOXFIRE-Global studies investigated the efficacy of combining first-line chemotherapy for metastatic colorectal cancer with selective internal radiotherapy (SIRT) using yttrium-90 resin microspheres in patients with liver metastases.1 The studies were designed for a prospective, combined analysis of overall survival, but also reported secondary endpoints including radiological response and liver-specific progression-free survival. Full-Text PDF