Elsevier

Clinical Oncology

Volume 20, Issue 3, April 2008, Pages 261-263
Clinical Oncology

Editorial
FOXFIRE: A Phase III Clinical Trial of Chemo-radio-embolisation as First-line Treatment of Liver Metastases in Patients with Colorectal Cancer

https://doi.org/10.1016/j.clon.2007.12.008Get rights and content

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  • Selective Internal Radiation Therapy in the Multidisciplinary Management of Liver Metastases From Colorectal Carcinoma

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    Median PFS was 9 months and median time to progression in the liver was 12 months. Following the promising results of their phase I/II data that established the maximum tolerated dose of oxaliplatin-fluorouracil chemotherapy in combination with SIRT, the FOXFIRE group of studies was conducted to compare FOLFOX with SIRT vs FOLFOX alone as first-line treatment for mCRC with liver-only or liver-predominant metastases.30-32 These three prospective randomized controlled, phase III clinical trials were conducted in 14 countries and enrolled over 1100 patients.

  • Selective internal radiation therapy for liver metastases from colorectal cancer

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    Importantly overall PFS was also improved by the addition of RFA, which differs to the results of SIRFLOX, and thus direct comparison is difficult [26]. Ultimately the ongoing randomized studies using oxaliplatin based chemotherapy in combination with SIRT (FOXFIRE and FOXFIRE Global) will provide important additional information in this setting [27] and will then trigger a planned combined OS analysis in 2017. Global recruitment was completed in January 2015 and we are awaiting results in the first half of 2017 (www.SIRTEX.com).

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    The embolization serves to increase chemotherapy efficacy and limit systemic exposure. Although used most commonly for unresectable primary hepatocellular carcinoma, TACE has demonstrated significant tumor response in preliminary trials for metastatic breast cancer,38 thyroid cancer,39 neuroendocrine cancers,40,41 melanoma,42-44 and colorectal cancer (CRC).45,46 Traditional TACE employs a variety of embolizing agents that transiently block tumor vasculature, including gelfoam, polyvinyl alcohol particles, and microspheres made of Tris-Acryl gelatin.47

  • Interventional oncology

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    Encouraging results seen in cohort series in patients with advanced mCRC who have undergone numerous lines of systemic chemotherapy,37 has led to a renewed enthusiasm to investigate its efficacy at an earlier stage in the disease. This is currently being investigated in a randomised trial of first line chemotherapy with or without SIRT.38 Percutaneous image guided cancer treatments require a multi-disciplinary approach.

  • Selective internal radiation therapy for liver tumours

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1

The FOXFIRE Trial Management Group consists of the authors plus Dr Adil Al-Nahhas (Hammersmith Hospital), Mr David Berry (Leicester), Dr Ian Chau (Royal Marsden Hospital), Professor Alastair Gray (Oxford), Professor David Kerr (Oxford), Dr Nas Khan (Royal Marsden Hospital), Dr Val Lewington (Royal Marsden Hospital), Dr Rachel Midgley (Oxford), Professor Will Steward (Leicester), Dr Paul Tait (Hammersmith Hospital), Dr Greg Wilson (Christie Hospital), Dr Bruno Morgan (Leicester), Dr Andy Wotherspoon (Royal Marsden Hospital).

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