I agree that oxaliplatin and iriotecan are equally effective (in the metastatic setting--oxaliplatin is clearly superior in the adjuvant setting) but the fact is almost all patients who receive oxaliplatin develop cumulative neurotoxicity, which lasts a long time and is only partly reversible.
On the other hand, the diarrhea associated with irinotecan is transient, reversible, and managable, particularly if physicians educate their patients and take an aggressive approach.
In fact, if you look at the Tournigan (GERCOR) study, which randomized patients to FOLFIRI or FOLFOX or the reverse sequence, you'll see that many patients who received FOLFOX had to stop therapy before resistance because of neurotoxicity.
In addition, irinotecan has reliable data in combination with bevacizumab (Hurwitz study, first-line) and cetuximab (BOND-1, second-line) and the combination of bevacizumab and cetuximab (BOND-2, second line). Admittedly the Hurwitz study is in combination with a bolus 5-FU regimen (IFL), which is no longer in favor, but one might expect even better results with an infusional 5-FU regimen.
In contrast, oxaliplatin has the E3200 study, which assessed the combination of oxaliplatin and bevacizumab in the second-line setting, and immature first-line data from the TREE-2 add-on study.
Of course, the lack of data for oxaliplatin with targeted agents hasn't stopped physicians from using the combination.
AI
