Colorectal Cancer Clinical Trial
Official title:
S1 Versus Capecitabine in the First Line Treatment of Metastatic Colorectal Cancer Patients, the SALTO Randomised Phase III Study of the Dutch Colorectal Cancer Group. A Safety Evaluation of Oral Fluoropyrimidines
The study is a two-arm randomised phase III trial. Patients will be randomised to receive capecitabine (arm A) or S-1 (arm B). Bevacizumab may be added according to the choice of the investigator. Patients will be followed 3-weekly at the outpatient clinic, toxicity will be assessed according to study protocol guidelines. Patients will be evaluated every 3 cycles for response. Upon disease progression patients will be treated according to the local investigators
Capecitabine, an oral fluoropyrimidine, has shown a comparable efficacy but a better
tolerability compared to bolus 5-FU/LV. However, capecitabine has a higher incidence of
hand-foot syndrome (HFS). HFS is characterized by erythema, dysesthesia and/or paresthesia of
the palms of the hands or soles of feet. In advanced stage, desquamation, ulceration and
blistering can occur. Although HFS is not life threatening, it can cause significant
discomfort and impairment of function, especially in elderly patients. This adverse event is
becoming particularly relevant since many patients may require the administration of
capecitabine over prolonged periods of time.
S-1 (Teysuno®) is an oral fluoropyrimidine that has shown comparable efficacy to 5FU and
capecitabine in gastrointestinal cancers but is associated with a much lower incidence of
HFS. Studies on S-1 have mainly been performed in Asian patients,which population has known
differences in tumour biology and toxicity compared to Western population. S-1 has shown
comparable efficacy to other fluoropyrimidines as monotherapy or in combination chemotherapy
schedules in several gastrointestinal tumors. However, given the lack of data from
prospective studies on S-1 as monochemotherapy in metastatic colorectal cancer in Western
patients, this study is designed to compare S-1 and capecitabine monotherapy in terms of
safety, with particular interest in HFS, in metastatic colorectal cancer patients.
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