68 Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide and ranks among the most common malignancies, along with lung, prostate, and breast cancers. While developed countries report high incidence rates, Pakistan—an underdeveloped country—is considered a low-risk region. In recent years, significant advances have been made in the treatment of CRC, including systemic chemotherapy and targeted therapies. In metastatic CRC, targeted agents such as cetuximab and bevacizumab have demonstrated promising efficacy, particularly when combined with standard chemotherapy regimens. However, their effectiveness in the Pakistani population remains unclear. This study summarizes and compares the therapeutic outcomes of two commonly used chemotherapy regimens, FOLFOX and FOLFIRI, in patients with metastatic CRC treated at a tertiary care hospital in Karachi, Pakistan. Methods: After receiving institutional review board approval, a total of 100 patients aged 18–65 years with untreated metastatic CRC were enrolled between May 2022 and February 2023. Patients with uncontrolled infections, prior chemotherapy (including irinotecan), brain metastases, colectomy, cardiovascular events, pregnancy, or significant psychiatric illness were excluded. Participants were randomized to receive either FOLFOX (n=50) or FOLFIRI (n=50), administered every two weeks for up to 12 cycles. Tumor response was assessed with CT scans at baseline and every 8 weeks. Toxicities were recorded at each cycle. Results: The overall response rate was 66% for FOLFIRI and 78% for FOLFOX. Median time to progression was 8 months with FOLFIRI and 9 months with FOLFOX (p=0.06). Median overall survival was 13 months and 14 months, respectively (p=0.28). Differences in efficacy were not statistically significant. Toxicity patterns differed: FOLFIRI was associated with nausea/vomiting (60%), neutropenia (46%), and anemia (44%), while FOLFOX more commonly caused neutropenia (48%), anemia (36%), and diarrhea (30%). Conclusions: This study provides real-world evidence to support treatment decisions for metastatic CRC in Pakistan and other resource-limited settings. Both FOLFOX and FOLFIRI demonstrated comparable efficacy, with FOLFOX showing a modest trend toward improved tumor control. Toxicity patterns differed, as hematologic adverse events were more frequent with FOLFOX, whereas gastrointestinal side effects predominated with FOLFIRI. These findings underscore the importance of tailoring chemotherapy selection to individual patient comorbidities and tolerance, and reinforce the need for locally relevant data to guide treatment guidelines.
Rani et al. (Sat,) studied this question.