The table below lists selected Grade ≥3 adverse events from the SIRFLOX study.
§Denotes statistically significant difference in incidence of adverse event
Overview of toxicities in other FOLFOX-based mCRC studies.
bev*: bevacizumab (bevacizumab allowed at investigator’s discretion, per institutional practice)
No statistically significant improvement of PFS at any site
van Hazel GA et al. J Clin Oncol 2016; 34: 1723–1731.
Listen to Dr. Marwan Fakih commenting on the management of toxicities observed in SIRFLOX.
Play VideoDr. Fakih’s key comments and takeaways:
- The number of grade 3 neutropenias reported in the SIRFLOX study was not by itself clinically significant and was not far from what has been observed with other FOLFOX chemotherapy regimens.
- Dr. Fakih comments that hematological side effects from SIRT can be treated by dose-reduction of oxaliplatin or by adding leukocyte growth factor.
- Most medical oncologists stop oxaliplatin after cycle eight; however SIRFLOX investigators continued oxaliplatin until progression or intolerance. Dr. Fakih assumes neutropenia was partially due to a cumulative treatment effect.
Listen to Dr. David Liu sharing his experience with managing SIRT-associated toxicities.
Dr. Liu’s key comments and takeaways:
- Although the incidence of REILD (Radioembolization Induced Liver Disease) within the SIRFLOX study was statistically significant, it very rarely presents itself in the day-to-day management of mCRC.
- The GI ulceration rate in the SIRFLOX study was higher than the 1-2% reported in the MORE study*. Dr Liu expects these rates to decrease as the SIRT procedure becomes more common in mainstream practice. In his experience, the learning curve of Interventional Radiologists has led to a reduced incidence of GI ulceration.
Kennedy AS et al. J Gastrointest Oncol 2015; 6: 134–142