Capecitabine Combined with Irinotecan for Metastatic Colorectal Cancer: A Meta Analysis_West China Medical Journal

Authors：

ZHOU Junxiang ^1,2 ,  JIANG Xuehua ² , XU Ting ¹ , TANG Yao ¹

1. Department of Pharmacy, West China Hospital; 2. West china School of Pharmacy; Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

JIANG Xuehua, Email: zhoujunxiang87@126.com

Keywords：

卡培他滨; 伊立替康; 结直肠肿瘤; Meta分析

Video：

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目的　评价卡培他滨+伊立替康与氟尿嘧啶/醛氢叶酸（5-FU/LV）+伊立替康治疗转移性结直肠癌的有效性和安全性。方法　计算机检索PubMed、CENTRAL、Embase、中国生物医学数据库、中国期刊全文数据库、维普数据库和万方数据库，检索时间均从建库至2011年9月。对符合纳入标准的随机对照试验进行质量评价和Meta分析。结果　纳入3个随机对照试验，共计419例患者，卡培他滨+伊立替康在中位生存期、完全缓解率[RR=1.58，95%CI（0.27，9.11），P=0.61]、部分缓解率[RR=0.86，95%CI（0.68，1.09），P=0.20]、总有效率[RR=0.88，95%CI（0.71，1.09），P=0.26]上表现出与5-FU/LV+伊立替康相似的效果，安全性方面卡培他滨+伊立替康有较高的Ⅲ/Ⅳ级恶心[RR=1.92，95%CI（1.05，3.54），P=0.04]、腹泻[RR=3.23，95%CI（2.14，4.89），P＜0.000 01]发生风险和较低的Ⅲ/Ⅳ级中性粒细胞减少[RR=0.72，95%CI（0.53，0.98），P=0.04]发生风险。结论　根据当前现有证据，5-FU/LV+伊立替康可能较卡培他滨+伊立替康更为有利于转移性结直肠癌患者的治疗，但仍需结合临床实际情况进行化疗方案的优选。

Citation： ZHOU Junxiang,JIANG Xuehua,XU Ting,TANG Yao. Capecitabine Combined with Irinotecan for Metastatic Colorectal Cancer: A Meta Analysis. West China Medical Journal, 2012, 27(5): 687-692. doi: Copy

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2.	Saltz LB. Adjuvant therapy for colon cancer[J]. Surg Oncol Clin N Am, 2010, 19(4): 819-827.
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9.	Hsu TC, Chen HH, Yang MC, et al. Pharmacoeconomic analysis of capecitabine versus 5-fluorouracil/leucovorin as adjuvant therapy for stage Ⅲ colon cancer in Taiwan[J]. Value Health, 2011, 14(5): 647-651.
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11.	Patt YZ, Lee FC, Liebmann JE, et al. Capecitabine plus 3-weekly irinotecan (XELIRI regimen) as first-line chemotherapy for metastatic colorectal cancer: phaseⅡ trial results[J]. Am J Clin Oncol, 2007, 30(4): 350-357.
12.	Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, et al. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group[J]. Br J Cancer, 2009, 101(7): 1039-1043.
13.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions Version 5.0.0[updated February 2008][EB/OL]. The Cochrane Collaboration, 2008. http://www.mrc-bsu.cam.ac.uk/cochrane/handbook500/.
14.	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(9): 120.
15.	Fuchs CS, Marshall J, Barrueco J. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: updated results from the BICC-C study[J]. J Clin Oncol, 2008, 26(4): 689-690.
16.	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.
17.	Toxicity of fluorouracil in patients with advanced colorectal cancer:effect of administration schedule, factors P. Meta-Analysis group in cancer[J]. J Clin Oncol, 1998, 16(11): 3537-3541.
18.	Zhang RX, Wu XJ, Lu SX, et al. The effect of COX-2 inhibitor on capecitabine-induced hand-foot syndrome in patients with stageⅡ/Ⅲ colorectal cancer: a phaseⅡ randomized prospective study[J]. J Cancer Res Clin Oncol, 2011, 137(6): 953-957.
19.	Kamil M, Haron M, Yosuff N, et al. High frequency of hand foot syndrome with capecitabine[J]. J Coll Physicians Surg Pak, 2010, 20(6): 421-422.

1. 　Benson AB 3rd. New approaches to the adjuvant therapy of colon cancer[J]. Oncologist, 2006, 11(9): 973-980.
2. 　Saltz LB. Adjuvant therapy for colon cancer[J]. Surg Oncol Clin N Am, 2010, 19(4): 819-827.
3. 　王艇, 罗黎力, 周清华, 等. 奥沙利铂联合5-FU/LV与伊立替康联合5-FU/LV比较治疗晚期结直肠癌的系统评价[J]. 中国循证医学杂志, 2008, 8(1): 36-41.
4. 　Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage Ⅲ colon cancer[J]. N Engl J Med, 2005, 352(26): 2696-2704.
5. 　Twelves C, Gollins S, Grieve R, et al. A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer[J]. Ann Oncol, 2006, 17(2): 239-245.
6. 　Koukourakis GV, Kouloulias V, Koukourakis MJ, et al. Efficacy of the oral fluorouracil pro-drug capecitabine in cancer treatment: a review[J]. Molecules, 2008, 13(8): 1897-1922.
7. 　Walko CM, Lindley C. Capecitabine: a review[J]. Clin Ther, 2005, 27(1): 23-44.
8. 　Haller DG, Tabernero J, Maroun J, et al. Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stageⅢ colon cancer[J]. J Clin Oncol, 2011, 29(11): 1465-1471.
9. 　Hsu TC, Chen HH, Yang MC, et al. Pharmacoeconomic analysis of capecitabine versus 5-fluorouracil/leucovorin as adjuvant therapy for stage Ⅲ colon cancer in Taiwan[J]. Value Health, 2011, 14(5): 647-651.
10. 　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.
11. 　Patt YZ, Lee FC, Liebmann JE, et al. Capecitabine plus 3-weekly irinotecan (XELIRI regimen) as first-line chemotherapy for metastatic colorectal cancer: phaseⅡ trial results[J]. Am J Clin Oncol, 2007, 30(4): 350-357.
12. 　Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, et al. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group[J]. Br J Cancer, 2009, 101(7): 1039-1043.
13. 　Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions Version 5.0.0[updated February 2008][EB/OL]. The Cochrane Collaboration, 2008. http://www.mrc-bsu.cam.ac.uk/cochrane/handbook500/.
14. 　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(9): 120.
15. 　Fuchs CS, Marshall J, Barrueco J. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: updated results from the BICC-C study[J]. J Clin Oncol, 2008, 26(4): 689-690.
16. 　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.
17. 　Toxicity of fluorouracil in patients with advanced colorectal cancer:effect of administration schedule, factors P. Meta-Analysis group in cancer[J]. J Clin Oncol, 1998, 16(11): 3537-3541.
18. 　Zhang RX, Wu XJ, Lu SX, et al. The effect of COX-2 inhibitor on capecitabine-induced hand-foot syndrome in patients with stageⅡ/Ⅲ colorectal cancer: a phaseⅡ randomized prospective study[J]. J Cancer Res Clin Oncol, 2011, 137(6): 953-957.
19. 　Kamil M, Haron M, Yosuff N, et al. High frequency of hand foot syndrome with capecitabine[J]. J Coll Physicians Surg Pak, 2010, 20(6): 421-422.

West China Medical Journal

Capecitabine Combined with Irinotecan for Metastatic Colorectal Cancer: A Meta Analysis

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