• Hidetomo Ajima, Hiroyasu Ogata, Ken-ichi Fujita, Keisuke Miwa, Yu Sunakawa, Keiko Mizuno, Hiroo Ishida, Keishi Yamashita, Hirofumi Nakayama, Kaori Kawara, Harumi Takahashi, and Yasutsuna Sasaki.
• Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Tokyo, Japan.
• Jpn. J. Clin. Oncol. 2010 Jul 1; 40 (7): 634-8.

ObjectiveRecently, significant progress in treatment of metastatic colorectal cancer has been achieved. Either FOLFIRI (fluorouracil, leucovorin and irinotecan) or modified FOLFOX6 (fluorouracil, leucovorin and oxaliplatin, oxaliplatin dose 85 mg/m(2)) is selected as first-line therapy in clinical practice in Japan. However, economic burden of colorectal cancer is considerable.MethodsAnalysis was made for all patients who were treated with FOLFIRI or modified FOLFOX6 for metastatic colorectal cancer. Regimen of FOLFIRI was compared with modified FOLFOX6 under consideration from clinical and economic standpoints. Progression free survival, response, toxicity and cancer care cost in patients with metastatic colorectal cancer was analyzed. Direct costs based on the fee schedule of the Japanese national health insurance were calculated.ResultsMedian progression free survival was 7.7 months for FOLFIRI versus 8.4 months for modified FOLFOX6 (P = 0.48). Overall cost for first four cycles was yen756 284 for FOLFIRI and yen1 081 162 for modified FOLFOX6 (P < 0.0001). All grade alopecia was significantly more frequent with FOLFIRI than with modified FOLFOX6 (P = 0.04). All grade neuropathy was more observed with modified FOLFOX6 than FOLFIRI (P = 0.0002).ConclusionsFOLFIRI is inexpensive in the initial stage of treatment which a number of patients can receive chemotherapy than modified FOLFOX6 as first-line therapy for metastatic colorectal cancer in Japanese national insurance system.

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