Systemic treatment of advanced colorectal cancer: FOLFOX or XELOX?

Sebastian Ochenduszko

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.

Keywords

oxaliplatin; 5-fluorouracil; capecitabine; XELOX; FOLFOX; bevacizumab

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