"The Oncologist" -- a bi-monthly international peer-reviewed journal for physicians devoted to cancer patient care -- reports on an important new anti-cancer drug, irinotecan (CPT-11; Camptosar(R); Pharmacia Inc.), in its latest issue (Vol. 6, No. 1, 2001).
Irinotecan, approved for first-line therapy in patients with metastatic
colorectal cancer, has been shown to increase progression-free survival, delay
tumor growth and also is showing potential in other cancer types.
The "Promising New Drugs and Combinations" section of the journal features
a commentary by Dr. Leonard B. Saltz of Memorial Sloan-Kettering Cancer
Center, as well as two research studies by Saltz and colleagues on the drug's
use in treating colorectal cancer, and a five-year review by Dr. Mace L.
Rothenberg of Vanderbilt-Ingram Cancer Center, of irinotecan's recent
treatment of other cancers.
In his commentary, "Irinotecan: A New Agent Comes of Age," Dr. Saltz
discusses how "in some respects the development of irinotecan served as a new
model for anticancer drug development," leading an international effort to
define and develop the drug as a treatment for colorectal cancer that was
resistant to the then-standard of care, fluorouracil (5-FU). This was the
first time a drug development strategy was focused on previously treated
patients who did not respond to chemotherapy, rather than on newly diagnosed
In "Irinotecan Plus Fluorouracil/Leucovorin for Metastatic Colorectal
Cancer: A New Survival Standard," Dr. Saltz and colleagues report on two
prospective, phase-III randomized, controlled, multi-center, multinational
clinical trials for patients with previously untreated metastatic colorectal
cancer. In separate studies, the combination of irinotecan with
5-FU/leucovorin extended survival time by 20 percent. It also showed a 50
percent overall tumor response rate and garnered a 50 percent increase in
median time to tumor progression, relative to treatment with 5-FU/leucovroin
alone for patients with advanced colorectal cancer. These results served as
the basis for the regimen's approval as first-line therapy for metastatic
colorectal cancer in the United States and Europe.
In "Irinotecan (CPT-11): Recent Developments and Future Directions;
Colorectal Cancer and Beyond," Dr. Rothenberg discusses phase II and III
studies suggesting "that irinotecan may have an important role in the
treatment of a number of other cancers, including small cell lung cancer and
non-small cell lung cancer, esophageal cancer, gastric cancer, cervical
cancer, malignant brain tumors and ovarian cancer," as well as pancreatic
cancer. He also notes that irinotecan may be more useful as a molecularly
targeted compound and sees future research focusing on better drug
combinations with irinotecan and using it in combination with radiation.
Clearly, irinotecan (CPT-11) represents a major new drug in the treatment
of aggressively growing tumors.