• Gastrointestinal Cancer Disease Site Group. Figueredo A, Moore M, Germond C, Kocha W, Maroun J, Zwaal C. Use of irinotecan in the second-line treatment of metastatic colorectal carcinoma. Toronto (ON): Cancer Care Ontario (CCO); 2004 Jul. 21 p. (Practice guideline report; no. 2-16). [40 references]

• The Gastrointestinal Cancer Disease Site Group (DSG) recommends second-line treatment with irinotecan, either alone or in combination with 5-fluorouracil/leucovorin, to selected patients in whom first-line therapy has failed.
• It is appropriate to offer irinotecan monotherapy as second-line treatment to patients following failure of first-line treatment with:
  • Infusional 5-fluorouracil/leucovorin and oxaliplatin (FOLFOX)
  • Bolus or infusional 5-fluorouracil/leucovorin (Mayo or de Gramont schedule)
  • Oral capecitabine
  • Raltitrexed
• Although based on non-randomized controlled trial evidence, the Gastrointestinal Disease Site Group supports second-line treatment with irinotecan, either alone or in combination with infusional 5-fluorouracil/leucovorin, as second-line treatment to patients following failure of first-line treatment with:
  • Infusional 5-fluorouracil/leucovorin and oxaliplatin.

None provided

Original Guideline: April 1999

Two randomized controlled trials (RCTs), six phase II trials, and one monograph were reviewed. The randomized controlled trials compared irinotecan with best supportive care (BSC) or 5-fluorouracil (5-FU) infusional chemotherapy in patients for whom first-line 5-FU bolus therapy failed. Three phase II studies also presented data on chemotherapy-naïve patients.

July 2004 Update

The recommendations are supported by randomized controlled trials.

• Gastrointestinal Cancer Disease Site Group. Figueredo A, Moore M, Germond C, Kocha W, Maroun J, Zwaal C. Use of irinotecan in the second-line treatment of metastatic colorectal carcinoma. Toronto (ON): Cancer Care Ontario (CCO); 2004 Jul. 21 p. (Practice guideline report; no. 2-16). [40 references]

Not applicable: The guideline was not adapted from another source.

1999 Apr 30 (revised 2004 Jul)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC), is a project supported by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Gastrointestinal Cancer Disease Site Group

Members of the Gastrointestinal Cancer Disease Site Group disclosed potential conflict of interest information.

None available

This summary was completed by ECRI on August 19, 1999. The information was verified by the guideline developer as of September 17, 1999. This NGC summary was updated by ECRI on December 3, 2001. The updated information was reviewed by the guideline developer as of January 10, 2002. This information was updated again by ECRI on May 14, 2004. The updated information was verified by the guideline developer on June 2, 2004. This NGC summary was updated on August 12, 2005. The updated information was verified by the guideline developer on September 13, 2005.