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Oral Uracil and Tegafur Plus Leucovorin Compared With Intravenous Fluorouracil and Leucovorin in Stage II and III Carcinoma of the Colon: Results From National Surgical Adjuvant Breast and Bowel Project Protocol C-06

Barry C. Lembersky, H. Samuel Wieand, Nicholas J. Petrelli, Michael J. O'Connell, Linda H. Colangelo, Roy E. Smith, Thomas E. Seay, Jeffrey K. Giguere, M. Ernest Marshall, Andrew D. Jacobs, Lauren K. Colman, Atilla Soran, Greg Yothers, Norman Wolmark

From the National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; Allegheny General Hospital, Pittsburgh; The Regional Cancer Center, Erie, PA; Helen F. Graham Cancer Center, Newark, DE; Atlanta Cancer Care, Inc, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; Southeastern Medical Oncology Center, Goldsboro, NC; Virginia Mason Medical Center, Seattle; and the Northwest Community Clinical Oncology Program, Tacoma, WA

Address reprint requests to Michael J. O'Connell, MD, National Surgical Adjuvant Breast and Bowel Project, Four Allegheny Center, Pittsburgh, PA 15212; e-mail: michael.o'connell{at}nsabp.org

PURPOSE: The primary aim of this study was to compare the relative efficacy of oral uracil and tegafur (UFT) plus leucovorin (LV) with the efficacy of weekly intravenous fluorouracil (FU) plus LV in prolonging disease-free survival (DFS) and overall survival (OS) after primary surgery for colon carcinoma.

PATIENTS AND METHODS: Between February 1997 and March 1999, 1,608 patients with stage II and III carcinoma of the colon were randomly assigned to receive either oral UFT+LV or intravenous FU+LV.

RESULTS: Of the total patients, 47% had stage II colon cancer, and 53% had stage III colon cancer. Median follow-up time was 62.3 months. The estimated hazard ratio (HR) for OS of patients who received UFT+LV versus that of patients who received FU+LV was 1.014 (95% CI, 0.825 to 1.246). The estimated HR for DFS was 1.004 (95% CI, 0.847 to 1.190). Cox proportional hazards model analyses with regard to age (< 60 v 60 years), stage, or number of involved nodes (none v one to three v four nodes) revealed no interaction with OS or DFS. Toxicity was similar in the two groups. In the UFT+LV arm, 38.2% of patients experienced any grade 3 or 4 toxic event compared with 37.8% of patients in the FU+LV arm. Primary quality-of-life end points did not differ between the two regimens, although convenience of care analysis favored UFT+LV.

CONCLUSION: UFT+LV achieved similar DFS and OS when compared with an intravenous, weekly, bolus FU+LV regimen. The two regimens were equitoxic and generally well tolerated.

Supported by Public Health Service Grant Nos. U10CA-12027, P-U10CA-37377, U10CA-69651, and U10CA-69974 from the National Cancer Institute, Department of Health and Human Services, and Bristol-Myers Squibb Pharmaceutical Research Institute, Wallingford, CT, and Taiho Pharmaceutical Co, Ltd, Tokyo, Japan.

Presented at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 13-17, 2004.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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