Oxaliplatine et thérapies ciblées

Oxaliplatin occupies a major place in the treatment of the gastro-intestinal cancers and particularly in colorectal cancers in combination with IV and oral fluoro-pyrimidines. However, the targeted therapies demonstrated rather at first their efficiency in combination with irinotecan-based chemotherapy, at least when recent results of phase III trials are considered. It is however possible to find in the literature direct and indirect arguments, suggesting that combinations of Folfox + anti-angiogenic or Folfox + anti-EGF receptors may become in the next future new standards. The combination Folfox + bevacizumab already showed superiority to Folfox alone in second line of chemotherapy of colorectal cancers with an improvement of the overall survival what is extremely rare in t he past. This association is so promising that it was the object of a phase III randomised trial in front line, the first results of which will be reported in a few months. Two studies of phase III evaluating the same combination in adjuvant settings are in progress with good recruitment. The combination of Folfox with cetuximab also gave very promising results in phase II studies. Randomised studies are ongoing in front line and in adjuvant setting. In other gastro-intestinal metastatic cancers, the interest of the combinations of oxaliplatin and targeted biotherapies is less clearly demonstrated as far as oxaliplatin-based schedules are less used in these tumours. However, it is possible that combinations of Folfox + targeted therapies for the cancer of the oesophagus and the stomach or Gemox + targeted therapies for the cancer of the pancreas become therapeutic options in the next future.