Due to the lack of conclusive evidence to identify the optimum dose of calcium folinate (Leucovorin®), it is the consensus of the eviQ reference committee to adopt flat dosing of calcium folinate (Leucovorin®) as a 50 mg IV bolus when used with bolus 5FU across all colorectal and upper gastrointestinal protocols. A discussion regarding the effect of dosing on outcome can be found in the calcium folinate (Leucovorin®) dose document.
The weekly fluorouracil (5-FU) plus leucovorin regimen, also commonly referred to as the Roswell Park regimen was evaluated for its efficacy by the National Surgical Adjuvant Breast and Bowel Project (NSABP C-03 trial) in patients with Duke's B and C colorectal cancer.r
Between August 1987 and April 1989, a total of 1081 patients were enrolled into the study and randomly assigned to receive either 5-FU 325 mg/m2/day day 1-5 and 375 mg/m2/day day 36-40, lomustine 130 mg/m2 on day 1 and vincristine 1 mg/m2 (max 2mg) on days 1 and 36 or 5-FU 500 mg/m2 and leucovorin 500 mg/m2 weekly for 6 weeks followed by 2 weeks break.
The primary end points of the study were disease-free survival and overall survival.r
In a more recent phase III trial (NSABP C-07), the efficacy of 3 cycles of the weekly Roswell Park regimen, FU 500 mg/m2 plus LV 500 mg/m2 weekly for 6 weeks for three 8-week cycles (FULV) was compared to 3 cycles of the the same FULV regimen with oxaliplatin 85 mg/m2 administered on week 1, 3, and 5 of each 8 week-cycle (FLOX).r The addition of oxaliplatin showed a disease-free survival benefit (HR, 0.82; 95% CI, 0.72 to 0.93; p=0.002). However, there was no statistically significant difference in overall survival (HR, 0.88; 95% CI, 0.75 to 1.02; p=0.08).r
Efficacy
After a follow-up of 3 years, the DFS rate and OS rate for 5-FU/FA versus MOF were 73% vs 64% and 84% vs 77% respectively. This translates to a 30% and 32% risk reduction in treatment failure and mortality respectively in patients receiving 5-FU/FA compared to MOF.r
Disease-free survivalr

© Journal of Clinical Oncology 1993
Overall survivalr

© Journal of Clinical Oncology 1993
Toxicity
Toxicityr |
FULV |
FLOX |
p-value |
Grade |
3 |
4 |
3 |
4 |
Diarrhoea |
32 |
<1 |
37 |
1 |
0.003 |
Dehydration |
11 |
<1 |
16 |
1 |
< 0.001 |
Nausea |
11 |
0 |
16 |
0 |
< 0.001 |
Vomiting |
8 |
<1 |
12 |
< 1 |
< 0.001 |
Fatigue |
3 |
<1 |
5 |
< 1 |
0.15 |
Neurosensory |
<1 |
0 |
8 |
0 |
< 0.001 |
Thrombosis or embolism |
4 |
1 |
3 |
1 |
0.78 |
© Journal of Clinical Oncology 2007