A patient preference study comparing raltitrexed ('Tomudex') and bolus or infusional 5-fluorouracil regimens in advanced colorectal cancer: influenceof side-effects and administration attributes

Current chemotherapy regimens used in advanced colorectal cancer (ACRC) are similar in terms of efficacy, but differ importantly in terms of side-effe cts and administration profiles. These differences may impact significantly on patients' lives. We have evaluated patient preferences between raltitre xed ('Tomudex') and 5-fluorouracil-based chemotherapy regimens, with regard to side-effect attributes (raltitrexed and Mayo regimens) and administrati on attributes (raltitrexed, Mayo, De Gramont and Lokich regimens) in a stud y based on 82 patients with ACRC. Patients completed a series of rating tas ks on how 'upsetting' these attributes were to them using a visual analogue scale (VAS) in a structured interview conducted by a research nurse. Mucos itis and asthenia were the most and least upsetting side-effects, respectiv ely. The side-effect profile of raltitrexed was clearly preferred by 78% of patients versus 14% for Mayo (P < 0.001). When side-effects and administra tion attributes were combined into an overall profile, 91% of patients sele cted raltitrexed as their clearly preferred regimen, versus 6% for Mayo (P < 0.001). The administration regimen of raltitrexed was ranked most accepta ble (mean rank score 1.5 compared with Mayo 2.6, De Gramont 2.7, and Lokich 3.3). Given similar palliative effects, patients with ACRC exhibit prefere nces for raltitrexed over other regimens, based on administration and/or si de-effect attributes. Such preferences should constitute an important part of decisions relating to the choice of chemotherapy regimen in ACRC.