1. ¹Ludwig Institute for Cancer Research, Austin Health, Melbourne, Victoria, Australia
2. ²Covance Pty Ltd, Canberra, Australian Capital Territory, Australia

Correspondence: Dr NC Tebbutt, Ludwig Institute for Cancer Research, Austin Hospital, 145-163 Studley Road, Heidelberg, Victoria 3084, Australia. E-mail: niall.tebbutt@ludwig.edu.au

Received 30 August 2006; Revised 13 December 2006; Accepted 14 December 2006; Published online 6 February 2007.

Abstract

Randomised trials have established the importance of oxaliplatin (O) and irinotecan (I) in advanced colorectal cancer (CRC). However, patients enrolled in clinical studies represent a restricted population and little is known about the use of O and I in the general population and the subsequent outcomes outside clinical studies. We used the Australian Health Insurance Commission (HIC) database to describe prescribing patterns of O and I and their impact on survival in all patients with 5-fluorouracil (5-FU) refractory CRC in Australia in 2002 and 2003. In 2999 patients, there was a marked increase in initial treatment with O rather than I; 48% of patients received O first in 2002 vs 66% in 2003 (P<0.001). Overall 40–45% of patients received both O and I; however, younger patients were more likely to receive both drugs (P<0.001). After 5-FU failure and treatment with O or I, the proportion of patients surviving 6 or 12 months was estimated to be 0.67 (95% CI, 0.66–0.69) and 0.42 (95% CI, 0.40–0.44), respectively. Survival was superior for patients who received both O and I; however, the sequence of agents had no impact. Older patients (70 years) had inferior survival no matter which drug was used as initial treatment. Analysis of the Australian HIC database provides a valuable means of assessing patterns of use and outcomes of new therapies.