Abstract
Background
Capecitabine is an oral fluoropyrimidine that is shown to have similar efficacy to
5-fluorouracil (5-FU) when used both alone and in combination with oxaliplatin in
the treatment of colorectal cancer (CRC). Capecitabine and irinotecan combinations
(XELIRI) have been developed for the treatment of this disease but randomized comparisons
with standard infusional 5-FU and irinotecan (FOLFIRI) showed conflicting results.
Patients and Methods
We searched the literature for randomized controlled trials comparing XELIRI to FOLFIRI
for the treatment of metastatic colorectal cancer. Odds ratios with 95% confidence
intervals were used to analyze dichotomous variables. Hazard ratios for progression
and death were combined with an inverse variance method based on logarithmic conversion.
The fixed-effect model and Mantel-Haenszel method were used. Heterogeneity was investigated
with the Q-test and I
2
. Sensitivity analyses were performed.Results
Only 3 studies were identified, involving a total of 450 patients. XELIRI was associated
with significantly shorter progression-free survival (PFS) and increased grade 3/4
gastrointestinal toxicities such as nausea, vomiting, and diarrhea. Severe neutropenia,
however, was significantly more frequent with FOLFIRI. No differences in responses
and febrile neutropenia events were observed.
Conclusion
Our analysis suggest that the 2 regimens are not equivalent. XELIRI remains an option
for the first-line treatment of metastatic CRC but FOLFIRI should be preferred as
it confers more benefits in terms of PFS and induces fewer GI toxicities.
Keywords
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Article info
Publication history
Accepted:
April 6,
2010
Received in revised form:
March 17,
2010
Received:
January 8,
2010
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