Efficacy and Safety of Metronomic Capecitabine in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Background and ObjectiveMetronomic capecitabine has been found to be useful in several types of cancers such as pancreatic cancer, breast cancer, gastrointestinal cancers, nasopharyngeal carcinoma, metastatic colorectal cancer etc. This unique systematic literature review and meta-analysis was undertaken to assess the effectiveness and safety of metronomic capecitabine as a treatment regimen for hepatocellular carcinoma.MethodA systematic search of major databases was performed. Eight studies that dealt with the use of metronomic capecitabine for HCC were selected, seven were non-RCTs, and one was an RCT. Meta-analysis of these studies was performed using Review manager v5.3 and STATA 15.1 software. The pooled prevalence of OS, PFS, ORR, Grade 1-2 AE, Grade 3-4 AEs were determined, including publication bias and sensitivity analysis.ResultEight studies met the inclusion criteria, combining the pooled data of 476 patients from safety and efficacy studies. The pooled prevalence of DCR and ORR achieved with metronomic capecitabine were 36% (95% CI 32-41) and 7% (95% CI 5-9) respectively. The median PFS and median OS were 3.57 months (95% CI 3.29-3.85) and 11.75 months (95% CI 10.56-12.95) respectively. The incidence of 3-4 grade AEs and 1-2 grade AEs were 38% (95% CI 32-44) and 73% (95% CI 67-79) respectively.ConclusionThis meta-analysis highlights metronomic capecitabine as a potential second-line therapy for HCC. However, effective management of capecitabine’s side effects is essential.