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Randomized Comparative Study of Tegafur/Uracil and Oral Leucovorin Versus Parenteral Fluorouracil and Leucovorin in Patients With Previously Untreated Metastatic Colorectal Cancer

James Carmichael, Tadeusz Popiela, David Radstone, Stephen Falk, Markus Borner, Amit Oza, Torben Skovsgaard, Stephane Munier, Christophe Martin

From the City Hospital, Nottingham; Weston Park Hospital, Sheffield; Bristol Oncology Center, Bristol, United-Kingdom; Jagiellonian University, Krakow, Poland; Inselspital Bern, Bern, Switzerland; Princess Margaret Hospital, Toronto, Canada; Herlev Amt Hospital, Copenhagen, Denmark; and Bristol-Myers Squibb Company, Waterloo, Belgium.

Address reprint requests to James Carmichael, MD, City Hospital NHS Trust Hucknall Road, NG5 1PB Nottingham, United-Kingdom; email: james.carmichael{at}nottingham.ac.uk.

Purpose: This phase III study compared the time to progression (TTP) of an oral regimen of dihydropyrimidine dehydrogenase inhibitory fluoropyrimidine composed of a fixed combination of tegafur and uracil in a 1:4 molar ratio (UFT) and leucovorin (LV) to intravenous (IV) fluorouracil (5-FU) and LV in previously untreated metastatic colorectal carcinoma (CRC) patients. Secondary end points were survival, tumor response, safety, and quality of life.

Patients and Methods: Between May 1996 and July 1997, 380 patients were randomized to receive either UFT (300 mg/m²/d) and LV (90 mg/d), administered for 28 days every 35 days, or 5-FU (425 mg/m²/d) and LV (20 mg/m²/d), given IV for 5 days every 35 days.

Results: No statistically significant difference in TTP was observed between treatments. With 320 events assessed, the median TTP was 3.4 months (95% Confidence interval [CI], 2.6 to 3.8) on UFT/LV and 3.3 months (95% CI, 2.5 to 3.7) on 5-FU/LV (P = .591, stratified log-rank test). There were no statistically significant differences in survival, tumor response, duration of response, and time to response. Substantial safety benefits were observed in patients treated with UFT/LV. They experienced significantly less stomatitis/mucositis (P < .001) and myelosuppression, resulting in fewer episodes of febrile neutropenia (P < .001) and less documented infection (P = .04). Concomitant medication usage was significantly greater on 5-FU/LV (P = .010). With respect to quality of life, after correcting for baseline imbalances, there were no significant differences between treatments for any scale, except diarrhea.

Conclusion: The oral UFT/LV regimen failed to achieve improved TTP; however, the study confirms significant safety improvements compared with bolus IV 5-FU/LV for the first-line treatment of metastatic CRC.

Supported by the Taiho Pharmaceutical Company, Tokyo, Japan, and the Bristol-Myers Squibb Company, Princeton, NJ.

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