A Meta-analysis of Capacitance Combined with Irinotecan <i>versus</i> Fluorouracil Combined with Irinotecan for Advanced Metastatic Colorectal Cancer_West China Medical Journal

Authors：

 SHILing ¹ ,  MEIYao-guo ² , WANGZhi ¹ , ZUOHong-bo ¹ , GONGMin-yong ¹

1. Department of Oncology, the First People's Hospital of Jiujiang, Jiujiang Jiangxi 332000, P. R. China;
2. Department of Oncology, Traditional Chinese Medicine Hospital of Jiujiang, Jiujiang, Jiangxi 332000, P. R. China;

Corresponding author：

MEIYao-guo, Email: 182540076@qq.com

Keywords：

Capecitabine; Irinotecan; Fluorouracil; Metastatic colorectal cancer

DOI：

10.7507/1002-0179.20150542

Video：

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Objective To assess the effectiveness and safety of capacitance combined with irinotecan (CAPIRI) versus fluorouracil combined with irinotecan (FOLFIRI) for patients with advanced metastatic colorectal cancer. Methods Databases such as Pubmed, Embase, Wanfang data, CNKI, Cochran Library were searched from January 2000 to October 2015. We evaluated the quality of randomized controlled trials (RCTs) and then extracted data from them. RevMan 5.2 software was used to perform the meta-analysis. Results Eight RCTs studies with 1 634 advanced metastatic colorectal cancer patients were included based on our standard. CAPIRI regimen was equal to FOLFIRI regimen in complete response rate [RR=1.17, 95%CI (0.70, 1.96), P=0.56], overall respond rate [RR=0.90, 95%CI (0.79, 1.03), P=0.12], disease control rate [RR=0.93, 95%CI (0.87, 1.00), P=0.06], median progression-free survival [HR=1.00, 95%CI (0.72, 1.37), P=0.99], and median overall survival [HR=0.94, 95%CI (0.63, 1.40), P=0.77]. For safety, higher incidence rate of grade 3/4 vomiting [RR=1.91, 95%CI (1.13, 3.22), P=0.02], diarrhea [RR=2.84, 95%CI (2.22, 3.63), P<0.000 01], hand-foot syndrome [RR=4.55, 95%CI (2.15, 9.61), P<0.000 1] were confirmed for CAPIRI. The two methods had similar toxicities: nausea [RR=0.77, 95%CI (0.64, 0.93), P=0.005], fatigue [RR=1.19, 95%CI (0.73, 1.94), P=0.47], febrile neutropenia [RR=1.59, 95%CI (0.89, 2.87), P=0.12], anemia [RR=1.74, 95%CI (0.59, 5.18), P=0.32], and leukopenia [RR=0.77, 95%CI (0.64, 0.93), P=0.005]. Conclusion Capecitabine combined with irinotecan treatment for advanced colorectal cancer is effective and its toxicity is acceptable.

Citation： SHILing, MEIYao-guo, WANGZhi, ZUOHong-bo, GONGMin-yong. A Meta-analysis of Capacitance Combined with Irinotecan versus Fluorouracil Combined with Irinotecan for Advanced Metastatic Colorectal Cancer. West China Medical Journal, 2015, 30(10): 1891-1900. doi: 10.7507/1002-0179.20150542 Copy

1.	Jemal A, Bray F, Center MM, et al. Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2):69-90.
2.	Rosati G, Cordio S, Bordonaro R, et al. Capecitabine in combination with oxaliplatin or irinotecan in elderly patients with advanced colorectal cancer:results of a randomized phase Ⅱ study[J]. Ann Oncol, 2010, 21(4):781-786.
3.	Patt Y, Liebmann T, Diamandidis D, et al. Final efficacy and safety findings from a phase Ⅱ trial of capecitabine (X) plus irinotecan (XELIRI) as first-line treatment for metastatic colorectal cancer (MCRC)[J]. Ann Oncol, 2004, 23:271.
4.	Uygun K, Bilici A, Kaya S, et al. XELIRI plus bevacizumab compared with FOLFIRI plus bevacizumab as first-line setting in patients with metastatic colorectal cancer:experiences at two-institutions[J]. Asian Pac J Cancer Prev, 2013, 14(4):2283-2288.
5.	Koopman M, Antonini NF, Douma J, et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (Cairo):a phase Ⅲ randomised controlled trial[J]. Lancet, 2007, 370(9582):135-142.
6.	Fuchs CS, Marshall J, Mitchell E, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer:results from the BICC-C Study[J]. J Clin Oncol, 2007, 25(30):4779-4786.
7.	Skof E, Rebersek M, Hlebanja Z, et al. Capecitabine plus irinotecan (XELIRI regimen) compared to 5-FU/LV plus irinotecan (FOLFIRI regimen) as neoadjuvant treatment for patients with unresectable liver-only metastases of metastatic colorectal cancer:a randomised prospective phase Ⅱ trial[J]. BMC Cancer, 2009, 9:120.
8.	Moosmann N, Von Weikersthal LF, Vehling-Kaiser U, et al. Cetuximab plus capecitabine and irinotecan compared with cetuximab plus capecitabine and oxaliplatin as first-line treatment for patients with metastatic colorectal cancer:AIO KRK-0104——a randomized trial of the German AIO CRC study group[J]. J Clin Oncol, 2011, 29(8):1050-1058.
9.	Giantonio BJ, Forastiere AA. The role of the Eastern Cooperative Oncology Group in establishing standards of cancer care:over 50 years of progress through clinical research[J]. Semin Oncol, 2008, 35(5):494-506.
10.	Padhani, AR, Ollivier L. The RECIST (Response Evaluation Criteria in Solid Tumors) criteria:implications for diagnostic radiologists[J]. Br J Radiol, 2001, 74(887):983-986.
11.	Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada[J]. J Natl Cancer Inst, 2000, 92(3):205-216.
12.	Julian PT, Higgins, Sally Green. Cochrane handbook for systematic reviews of interventions, Version 5.1[DB/OL]. Updated March 2011, Cited March 2014. http://handbook.cochrane.org.
13.	Köhne CH, De Greve J, Hartmann JT, et al. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015[J]. Ann Oncol, 2008, 19(5):920-926.
14.	Ducreux M, Adenis A, Pignon JP, et al. Efficacy and safety of bevacizumab-based combination regimens in patients with previously untreated metastatic colorectal cancer:final results from a randomised phase Ⅱ study of bevacizumab plus 5-fluorouracil, leucovorin plus irinotecan versus bevacizumab plus capecitabine plus irinotecan (FNCLCC ACCORD 13/0503 study)[J]. Eur J Cancer, 2013, 49(6):1236-1245.
15.	Souglakos J, Ziras N, Kakolyris S, et al. Randomised phase-Ⅱ trial of CAPIRI (capecitabine, irinotecan) plus bevacizumab vs FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) plus bevacizumab as first-line treatment of patients with unresectable/metastatic colorectal cancer (mCRC)[J]. Br J Cancer, 2012, 106(3):453-459.
16.	Pectasides D, Papaxoinis G, Kalogeras KT, et al. XELIRI-bevacizumab versus FOLFIRI-bevacizumab as first-line treatment in patients with metastatic colorectal cancer:a Hellenic Cooperative Oncology Group phase Ⅲ trial with collateral biomarker analysis[J]. BMC Cancer, 2012, 12:271.
17.	Jackson NA, Barrueco J, Soufi-Mahjoubi R, et al. Comparing safety and efficacy of first-line irinotecan/fluoropyrimidine combinations in elderly versus nonelderly patients with metastatic colorectal cancer:findings from the bolus, infusional, or capecitabine with camptostar-celecoxib study[J]. Cancer, 2009, 115(12):2617-2629.
18.	Ocvirk J, Rebersek M, Boc M. Bevacizumab in first-line therapy of metastatic colorectal cancer:a retrospective comparison of FOLFIRI and XELIRI[J]. Anticancer Res, 2011, 31(5):1777-1782.
19.	Van Cutsem E, Findlay M, Osterwalder B, et al. Capecitabine, an oral fluoropyrimidine carbamate with substantial activity in advanced colorectal cancer:results of a randomized phase Ⅱ study[J]. J Clin Oncol, 2000, 18(6):1337-1345.
20.	Bajetta E, Di Bartolomeo M, Mariani L, et al. Randomized multicenter Phase Ⅱ trial of two different schedules of irinotecan combined with capecitabine as first-line treatment in metastatic colorectal carcinoma[J]. Cancer, 2004, 100(2):279-287.
21.	Borner MM, Bernhard J, Dietrich D, et al. A randomized phaseⅡ trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer:efficacy, quality-of-life and toxicity[J]. Ann Oncol, 2005, 16(2):282-288.
22.	Rea DW, Nortier JW, Ten Bokkel Huinink WW, et al. A phase Ⅰ/Ⅱ and pharmacokinetic study of irinotecan in combination with capecitabine as first-line therapy for advanced colorectal cancer[J]. Ann Oncol, 2005, 16(7):1123-1132.
23.	Renouf DJ, Welch S, Moore MJ, et al. A phase Ⅱ study of capecitabine, irinotecan, and bevacizumab in patients with previously untreated metastatic colorectal cancer[J]. Cancer Chemother Pharmacol, 2012, 69(5):1339-1344.
24.	Rothenberg ML, Meropol NJ, Poplin EA, et al. Mortality associated with irinotecan plus bolus fluorouracil/leucovorin:summary findings of an independent panel[J]. J Clin Oncol, 2001, 19(18):3801-3807.
25.	Reinacher-Schick AC, Kubicka S, Freier W, et al. Activity of the combination of bevacizumab (Bev) with capecitabine/irinotecan (CapIri/Bev) or capecitabine/oxaliplatin (CapOx/Bev) in advanced colorectal cancer (ACRC):a randomized phase Ⅱ study of the AIO Colorectal Study Group (AIO trial 0604)[J]. J Clin Oncol, 2008, 26:4030.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2):69-90.
2. Rosati G, Cordio S, Bordonaro R, et al. Capecitabine in combination with oxaliplatin or irinotecan in elderly patients with advanced colorectal cancer:results of a randomized phase Ⅱ study[J]. Ann Oncol, 2010, 21(4):781-786.
3. Patt Y, Liebmann T, Diamandidis D, et al. Final efficacy and safety findings from a phase Ⅱ trial of capecitabine (X) plus irinotecan (XELIRI) as first-line treatment for metastatic colorectal cancer (MCRC)[J]. Ann Oncol, 2004, 23:271.
4. Uygun K, Bilici A, Kaya S, et al. XELIRI plus bevacizumab compared with FOLFIRI plus bevacizumab as first-line setting in patients with metastatic colorectal cancer:experiences at two-institutions[J]. Asian Pac J Cancer Prev, 2013, 14(4):2283-2288.
5. Koopman M, Antonini NF, Douma J, et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (Cairo):a phase Ⅲ randomised controlled trial[J]. Lancet, 2007, 370(9582):135-142.
6. Fuchs CS, Marshall J, Mitchell E, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer:results from the BICC-C Study[J]. J Clin Oncol, 2007, 25(30):4779-4786.
7. Skof E, Rebersek M, Hlebanja Z, et al. Capecitabine plus irinotecan (XELIRI regimen) compared to 5-FU/LV plus irinotecan (FOLFIRI regimen) as neoadjuvant treatment for patients with unresectable liver-only metastases of metastatic colorectal cancer:a randomised prospective phase Ⅱ trial[J]. BMC Cancer, 2009, 9:120.
8. Moosmann N, Von Weikersthal LF, Vehling-Kaiser U, et al. Cetuximab plus capecitabine and irinotecan compared with cetuximab plus capecitabine and oxaliplatin as first-line treatment for patients with metastatic colorectal cancer:AIO KRK-0104——a randomized trial of the German AIO CRC study group[J]. J Clin Oncol, 2011, 29(8):1050-1058.
9. Giantonio BJ, Forastiere AA. The role of the Eastern Cooperative Oncology Group in establishing standards of cancer care:over 50 years of progress through clinical research[J]. Semin Oncol, 2008, 35(5):494-506.
10. Padhani, AR, Ollivier L. The RECIST (Response Evaluation Criteria in Solid Tumors) criteria:implications for diagnostic radiologists[J]. Br J Radiol, 2001, 74(887):983-986.
11. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada[J]. J Natl Cancer Inst, 2000, 92(3):205-216.
12. Julian PT, Higgins, Sally Green. Cochrane handbook for systematic reviews of interventions, Version 5.1[DB/OL]. Updated March 2011, Cited March 2014. http://handbook.cochrane.org.
13. Köhne CH, De Greve J, Hartmann JT, et al. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015[J]. Ann Oncol, 2008, 19(5):920-926.
14. Ducreux M, Adenis A, Pignon JP, et al. Efficacy and safety of bevacizumab-based combination regimens in patients with previously untreated metastatic colorectal cancer:final results from a randomised phase Ⅱ study of bevacizumab plus 5-fluorouracil, leucovorin plus irinotecan versus bevacizumab plus capecitabine plus irinotecan (FNCLCC ACCORD 13/0503 study)[J]. Eur J Cancer, 2013, 49(6):1236-1245.
15. Souglakos J, Ziras N, Kakolyris S, et al. Randomised phase-Ⅱ trial of CAPIRI (capecitabine, irinotecan) plus bevacizumab vs FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) plus bevacizumab as first-line treatment of patients with unresectable/metastatic colorectal cancer (mCRC)[J]. Br J Cancer, 2012, 106(3):453-459.
16. Pectasides D, Papaxoinis G, Kalogeras KT, et al. XELIRI-bevacizumab versus FOLFIRI-bevacizumab as first-line treatment in patients with metastatic colorectal cancer:a Hellenic Cooperative Oncology Group phase Ⅲ trial with collateral biomarker analysis[J]. BMC Cancer, 2012, 12:271.
17. Jackson NA, Barrueco J, Soufi-Mahjoubi R, et al. Comparing safety and efficacy of first-line irinotecan/fluoropyrimidine combinations in elderly versus nonelderly patients with metastatic colorectal cancer:findings from the bolus, infusional, or capecitabine with camptostar-celecoxib study[J]. Cancer, 2009, 115(12):2617-2629.
18. Ocvirk J, Rebersek M, Boc M. Bevacizumab in first-line therapy of metastatic colorectal cancer:a retrospective comparison of FOLFIRI and XELIRI[J]. Anticancer Res, 2011, 31(5):1777-1782.
19. Van Cutsem E, Findlay M, Osterwalder B, et al. Capecitabine, an oral fluoropyrimidine carbamate with substantial activity in advanced colorectal cancer:results of a randomized phase Ⅱ study[J]. J Clin Oncol, 2000, 18(6):1337-1345.
20. Bajetta E, Di Bartolomeo M, Mariani L, et al. Randomized multicenter Phase Ⅱ trial of two different schedules of irinotecan combined with capecitabine as first-line treatment in metastatic colorectal carcinoma[J]. Cancer, 2004, 100(2):279-287.
21. Borner MM, Bernhard J, Dietrich D, et al. A randomized phaseⅡ trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer:efficacy, quality-of-life and toxicity[J]. Ann Oncol, 2005, 16(2):282-288.
22. Rea DW, Nortier JW, Ten Bokkel Huinink WW, et al. A phase Ⅰ/Ⅱ and pharmacokinetic study of irinotecan in combination with capecitabine as first-line therapy for advanced colorectal cancer[J]. Ann Oncol, 2005, 16(7):1123-1132.
23. Renouf DJ, Welch S, Moore MJ, et al. A phase Ⅱ study of capecitabine, irinotecan, and bevacizumab in patients with previously untreated metastatic colorectal cancer[J]. Cancer Chemother Pharmacol, 2012, 69(5):1339-1344.
24. Rothenberg ML, Meropol NJ, Poplin EA, et al. Mortality associated with irinotecan plus bolus fluorouracil/leucovorin:summary findings of an independent panel[J]. J Clin Oncol, 2001, 19(18):3801-3807.
25. Reinacher-Schick AC, Kubicka S, Freier W, et al. Activity of the combination of bevacizumab (Bev) with capecitabine/irinotecan (CapIri/Bev) or capecitabine/oxaliplatin (CapOx/Bev) in advanced colorectal cancer (ACRC):a randomized phase Ⅱ study of the AIO Colorectal Study Group (AIO trial 0604)[J]. J Clin Oncol, 2008, 26:4030.

West China Medical Journal

A Meta-analysis of Capacitance Combined with Irinotecan versus Fluorouracil Combined with Irinotecan for Advanced Metastatic Colorectal Cancer

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