Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

Abstract

Background:The differences in efficacy between capecitabine and 5-fuorouracil (5-FU) in neoadjuvant chemoradiotherapy (CRT) of locally advanced rectal cancer (LARC) are not well recognized. We performed this meta-analysis to analyze the effect of capecitabine and 5-FU on neoadjuvant CRT to more accurately understand the differences between the 2 drugs.Methods:MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database were performed to identify all published studies investigating the efficacy of capecitabine in neoadjuvant CRT of LARC versus 5-FU before August, 2017. Primary endpoint was the odds ratio (OR) for improving pathological complete response (pCR) rate of patients with LARC. Secondary endpoints were the ORs of efficiency for downstaging tumor and increasing R0 resection in patients with LARC. Safety analyses were also performed. The OR was the principal measurement of effect, which was calculated as capecitabine group versus 5-FU group, and was presented as a point estimate with 95% confidence intervals (CIs). All calculations and statistical tests were performed using RevMan 5.3 software.Results:In all, 2916 patients with LARC enrolled in the 10 studies were divided into capecitabine group (n = 1451) and 5-FU group (n = 1465). The meta-analysis showed that capecitabine improved pCR (OR 1.34, 95% CI 1.10–1.63), and R0 resection rate (OR 1.92, 95% CI 1.10–3.36). There were no statistically significant differences either in overall downstaging rate (OR 1.31, 95% CI 0.79–2.16) or in the tumor downstaging rate (OR 1.24, 95% CI 0.79–1.92), but there was a significant difference of the nodal downstaging rate between the 2 groups (OR 1.68, 95% CI 1.11–2.54). There was no statistically significant difference in sphincter preservation rate between the 2 groups (OR 1.36, 95% CI 0.96–1.92). No obvious safety concerns about mortality and complications were raised in these studies. There were no statistically significant differences in 3-year disease-free-survival (OR 1.29, 95% CI 0.75–2.20), and in grade 3 to 4 acute toxicity during CRT (OR 0.63, 95% CI 0.31–1.30).Conclusions:Compared with 5-FU-based neoadjuvant CRT, capecitabine-based neoadjuvant CRT can safely improve pCR, nodal down-staging, ad R0 resection of patients with LARC.

Does capecitabine maintenance therapy versus active monitoring confer a survival benefit after first-line treatment of metastatic colorectal cancer? A meta-analysis of randomized controlled trials

“…There was no signi cant difference in the incidence of other grade 3-4 adverse events between the two groups, suggesting that capecitabine maintenance therapy). The increase in hand-foot skin reaction is similar to the results reported in published meta-analyses by [19], Zhan Wang [6], J. Zhu [20], Z. Wu [21] and others. There was no signi cant difference in the incidence of other grade 3-4 adverse events between the two groups, suggesting that capecitabine maintenance therapy is a safe method.…”

Characteristics of patients presented with metastases during or after completion of chemo-radiation therapy (CRT) for locally advanced rectal cancer: a case series

“…In our study, patients who developed early metastases received capecitabine frequently as a radiosensitizer. This does not mean that it is a weaker chemotherapeutic agent but inversely its effect had been approved by multiple studies [ 17 - 19 ]. This result may be attributed to the small number of our patients; hence, further studies with a larger number of cases are recommended.…”

History of Paclitaxel and Oral Paclitaxel – Clinical Data and Future

“…[14] Capecitabine-based neoadjuvant chemoradiotherapy has also shown improvement in pCR, ad R 0 resection, and nodal downstaging in patients with locally advanced rectal cancer when compared with 5-FU-based neoadjuvant chemoradiotherapy. [15] A pharmacoeconomic analysis of capecitabine and 5-FU was carried out by Cassidy et al, [16] wherein clinical effectiveness, chemotherapy costs, expenses toward managing adverse events, and costs for time and travel were assessed. The study showed that the average expenses toward medication for the management of adverse events was lower in the capecitabine treatment arm compared with the 5-FU/LV treatment arm (£86 and £345, respectively) and mean travel cost per patient was lower with capecitabine (£62) compared with 5-FU/LV (£196).…”