Phase III Study of Fluorouracil, Leucovorin, and Levamisole in High-Risk Stage II and III Colon Cancer: Final Report of Intergroup 0089

TLDR

In 1990, fluorouracil plus levamisole for one year became the standard adjuvant therapy for high‑risk stage II and III colon cancer. INT‑0089 randomized 3,794 high‑risk colon cancer patients to one of three 30‑32‑week regimens—low‑dose leucovorin plus FU, high‑dose leucovorin plus FU, or low‑dose leucovorin plus levamisole plus FU—against a levamisole‑plus‑FU control to evaluate the contributions of leucovorin and levamisole. After a median 10‑year follow‑up of 3,561 eligible patients, no regimen improved disease‑free or overall survival, with 47 % mortality, 37 % recurrence, and 48 % remaining disease‑free, and the 6‑ to 8‑month leucovorin‑plus‑FU regimens have since become widely adopted.

Abstract

In 1990, fluorouracil (FU) plus levamisole for 1 year became standard adjuvant treatment for patients with high-risk stages II and III colon cancer. Intergroup (INT) 0089 assessed the relative contributions of leucovorin and levamisole in such patients.From 1988 to 1992, 3,794 patients were randomly assigned. Experimental treatment consisted of one of three chemotherapy regimens: the low-dose leucovorin plus FU (Mayo Clinic; LDLV) regimen, the high-dose leucovorin plus FU (Roswell Park; HDLV) regimen, and the low-dose leucovorin plus levamisole plus FU (LDLV plus LEV) regimen, each administered for 30 to 32 weeks. The control arm was levamisole plus FU (LEV) for 1 year.After a median follow-up of 10 years, of 3,561 eligible patients, 1,691 (47%) have died and 1,330 (37%) have experienced disease recurrence; 137 (10%) of those experiencing recurrence are still alive. A total of 481 patients (13%) died without evidence of recurrence, and 1,723 (48%) are alive and disease free. Although there were toxicity differences among the four arms, none was statistically superior in disease-free or overall survival.The 6- to 8-month regimens of LDLV and HDLV without levamisole used in this trial, rather than the previous standard regimen of 12 months of LEV, have become widely used. INT-0089 has long-term follow-up of the largest clinical trial of patients with high-risk colon cancer, documenting not only the durability of the treatment effects, but also the natural history of patients with high-risk colon cancer, and analyses of treatment based on age, race, and comorbid conditions such as obesity, diabetes, and second primary cancers.