Efficacy and safety of capecitabine combined with irinotecan <i>versus</i> capecitabine combined with oxaliplatin in treatment of advanced/metastatic colorectal cancer: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

HE Yumei , TIAN Lei ,  MA Aixia

School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, P.R.China;

Corresponding author：

MA Aixia, Email: aixiama73@126.com

Keywords：

Capecitabine; Oxaliplatin; Irinotecan; Colorectal cancer; Efficacy; Safety; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201809002

Video：

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Objective To systematically review the efficacy and safety of capecitabine combined with irinotecan (CAPIRI) versus capecitabine combined with oxaliplatin (CAPOX) for patients with advanced/metastatic colorectal cancer.Methods PubMed, EMbase, The Cochrane Library, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on CAPIRI versus CAPOX for patients with advanced/metastatic colorectal cancer from inception to August 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 12 RCTs involving 1 049 patients were included. The results of meta-analysis showed that: there were no significant differences in complete response (CR), partial response (PR), stable disease (SD), progression disease (PD), overall respond rate (ORR), median progression-free survival (mPFS), and median overall survival (mOS) between two groups (P>0.05). However, CARIRI group was lower on the disease control rate (RR=0.93, 95%CI 0.86 to 1.00, P=0.04) than CAPOX group. Incidence of diarrhea was higher in CAPIRI group (RR=1.83, 95%CI 1.37 to 2.45, P<0.000 1). However, the incidence rate of peripheral neurotoxicity in CAPOX group was higher (RR=0.13, 95%CI 0.05 to 0.35, P<0.000 1). There were no significant differences between two groups in the incidence rates of nausea and vomiting, hand-foot syndrome, anemia, thrombocytopenia, leukocytopenia and alopecia (P>0.05).Conclusions Current evidence shows that two groups are equivalent in terms of curative effects. CAPIRI has a higher incidence rate of diarrhea, while CAPOX has a higher risk of peripheral neurotoxicity. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： HE Yumei, TIAN Lei, MA Aixia. Efficacy and safety of capecitabine combined with irinotecan versus capecitabine combined with oxaliplatin in treatment of advanced/metastatic colorectal cancer: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(3): 302-309. doi: 10.7507/1672-2531.201809002 Copy

1.	Jemal A, Center MM, DeSantis C, et al. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev, 2010, 19(8): 1893-1907.
2.	周慧俊, 殷先利, 刘振洋, 等. mFOLFOX6方案与CapeOX方案治疗老年转移性结直肠癌临床疗效分析. 实用临床医药杂志, 2013, 17(13): 33-36.
3.	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. Ann Oncol, 2010, 21(4): 781-786.
4.	Twelves C, Scheithauer W, Mckendrick J, et al. 1 LB 5-year overall survival update from the X-ACT trial of capecitabine vs. 5-FU/LV as adjuvant treatment for stage-III colon cancer. EJC Suppl, 2007, 5(6): 1.
5.	周俊翔, 余文韬, 徐珽, 等. XELOX方案与FOLFOX方案治疗转移性结直肠癌的系统评价. 中国药房, 2012, 23(14): 1295-1299.
6.	Tucker SJ, Pelusi J. Capecitabine versus 5-FU in metastatic colorectal cancer: considerations for treatment decision-making. Community Oncology, 2006, 3(1): 19-27.
7.	李文桦, 张文. 晚期结直肠癌的化疗进展. 中国癌症杂志, 2015, 25(11): 877-889.
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10.	Assy N, Basher W, Chetver L, et al. First-line treatment with capecitabine combined with irinotecan in patients with advanced colorectal carcinoma: a phase II study. J Clin Gastroenterol, 2012, 46(4): e27-e30.
11.	孟宪禄, 樊青霞, 王春燕. 伊立替康联合卡培他滨在晚期直肠癌的临床疗效观察. 医药论坛杂志, 2013, 34(5): 52-53, 56.
12.	杨瑞萍, 安艳海, 黎盼盼, 等. 伊立替康联合卡培他滨治疗晚期结直肠癌68例临床观察. 内科, 2015, 10(5): 688-689.
13.	Cartwright T, Lopez T, Vukelja SJ, et al. Results of a phase II open-label study of capecitabine in combination with irinotecan as first-line treatment for metastatic colorectal cancer. Clin Colorectal Cancer, 2005, 5(1): 50-56.
14.	Grothey A, Jordan K, Kellner O, et al. 295 Capecitabine plus irinotecan (CAPIRI) vs. capecitabine plus oxaliplatin (CAPOX) as first-line therapy of advanced colorectal cancer (ACRC): updated results of a randomized phase II trial. EJC Suppl, 2003, 1(5): S90-S91.
15.	Jordan K, Kellner O, Kegel T, et al. Phase II trial of capecitabine/irinotecan and capecitabine/oxaliplatin in advanced gastrointestinal cancers. Clin Colorectal Cancer, 2004, 4(1): 46-50.
16.	曹玉娟, 王德林, 刘承伟, 等. 伊立替康或奥沙利铂联合卡培他滨治疗结直肠癌伴肝转移的临床研究. 中国肿瘤临床, 2014, 41(9): 593-596.
17.	李大鹏, 任红, 李建柱. 奥沙利铂联合卡培他滨方案和伊立替康联合卡培他滨方案一线治疗K-ras突变型结直肠癌的疗效对比分析. 中国临床医生杂志, 2016, 44(12): 72-75.
18.	刘崇远, 吕鲁闽, 徐宝康. 卡培他滨联合奥沙利铂或伊立替康治疗转移性结直肠癌的疗效与安全性. 中国临床药理学杂志, 2014, 30(10): 907-908, 918.
19.	刘慧燕, 张斌. 奥沙利铂或伊立替康联合卡培他滨治疗晚期结直肠癌的临床研究. 中国临床药理学杂志, 2013, 29(4): 243-245.
20.	罗秦英, 罗敏娜, 唐露, 等. 奥沙利铂或伊立替康联合卡培他滨治疗转移性结直肠癌的临床研究. 中华临床医师杂志(电子版), 2013, 7(17): 76-79.
21.	尚品杰. 奥沙利铂或伊立替康联合卡培他滨治疗晚期转移性肠癌的临床疗效及安全性评价. 中国临床药理学杂志, 2015, 31(24): 2396-2398.
22.	孙慧琼, 薛立光, 杜丽坤. 伊立替康/奥沙利铂联合卡培他滨治疗晚期结肠癌的疗效比较. 中外医疗, 2016, 35(19): 152-153.
23.	张学良, 王健, 徐爱兵. 奥沙利铂联合卡培他滨与伊立替康联合卡培他滨治疗晚期大肠癌的临床比较. 齐齐哈尔医学院学报, 2011, 32(13): 2097-2098.
24.	郑涛, 陈熙. 伊立替康或奥沙利铂联合卡培他滨治疗结直肠癌伴肝转移. 中国继续医学教育, 2018, 10(10): 133-134.
25.	周俊翔, 余文韬, 徐珽. 卡培他滨联合奥沙利铂治疗转移性结直肠癌的系统评价. 厦门: 《医院处方分析合作项目》全国年会, 2012.

1. Jemal A, Center MM, DeSantis C, et al. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev, 2010, 19(8): 1893-1907.
2. 周慧俊, 殷先利, 刘振洋, 等. mFOLFOX6方案与CapeOX方案治疗老年转移性结直肠癌临床疗效分析. 实用临床医药杂志, 2013, 17(13): 33-36.
3. 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. Ann Oncol, 2010, 21(4): 781-786.
4. Twelves C, Scheithauer W, Mckendrick J, et al. 1 LB 5-year overall survival update from the X-ACT trial of capecitabine vs. 5-FU/LV as adjuvant treatment for stage-III colon cancer. EJC Suppl, 2007, 5(6): 1.
5. 周俊翔, 余文韬, 徐珽, 等. XELOX方案与FOLFOX方案治疗转移性结直肠癌的系统评价. 中国药房, 2012, 23(14): 1295-1299.
6. Tucker SJ, Pelusi J. Capecitabine versus 5-FU in metastatic colorectal cancer: considerations for treatment decision-making. Community Oncology, 2006, 3(1): 19-27.
7. 李文桦, 张文. 晚期结直肠癌的化疗进展. 中国癌症杂志, 2015, 25(11): 877-889.
8. Clinical Practice Guidelines in Oncology (NCCN Guidelines®): 2017 Guidelines. Available at: http://www.ascopost.com/issues/may-25-2017/nccn-clinical-practice-guidelines-in-oncology-nccn-guidelines-2017-guidelines/.
9. 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. Lancet, 2007, 370(9582): 135-142.
10. Assy N, Basher W, Chetver L, et al. First-line treatment with capecitabine combined with irinotecan in patients with advanced colorectal carcinoma: a phase II study. J Clin Gastroenterol, 2012, 46(4): e27-e30.
11. 孟宪禄, 樊青霞, 王春燕. 伊立替康联合卡培他滨在晚期直肠癌的临床疗效观察. 医药论坛杂志, 2013, 34(5): 52-53, 56.
12. 杨瑞萍, 安艳海, 黎盼盼, 等. 伊立替康联合卡培他滨治疗晚期结直肠癌68例临床观察. 内科, 2015, 10(5): 688-689.
13. Cartwright T, Lopez T, Vukelja SJ, et al. Results of a phase II open-label study of capecitabine in combination with irinotecan as first-line treatment for metastatic colorectal cancer. Clin Colorectal Cancer, 2005, 5(1): 50-56.
14. Grothey A, Jordan K, Kellner O, et al. 295 Capecitabine plus irinotecan (CAPIRI) vs. capecitabine plus oxaliplatin (CAPOX) as first-line therapy of advanced colorectal cancer (ACRC): updated results of a randomized phase II trial. EJC Suppl, 2003, 1(5): S90-S91.
15. Jordan K, Kellner O, Kegel T, et al. Phase II trial of capecitabine/irinotecan and capecitabine/oxaliplatin in advanced gastrointestinal cancers. Clin Colorectal Cancer, 2004, 4(1): 46-50.
16. 曹玉娟, 王德林, 刘承伟, 等. 伊立替康或奥沙利铂联合卡培他滨治疗结直肠癌伴肝转移的临床研究. 中国肿瘤临床, 2014, 41(9): 593-596.
17. 李大鹏, 任红, 李建柱. 奥沙利铂联合卡培他滨方案和伊立替康联合卡培他滨方案一线治疗K-ras突变型结直肠癌的疗效对比分析. 中国临床医生杂志, 2016, 44(12): 72-75.
18. 刘崇远, 吕鲁闽, 徐宝康. 卡培他滨联合奥沙利铂或伊立替康治疗转移性结直肠癌的疗效与安全性. 中国临床药理学杂志, 2014, 30(10): 907-908, 918.
19. 刘慧燕, 张斌. 奥沙利铂或伊立替康联合卡培他滨治疗晚期结直肠癌的临床研究. 中国临床药理学杂志, 2013, 29(4): 243-245.
20. 罗秦英, 罗敏娜, 唐露, 等. 奥沙利铂或伊立替康联合卡培他滨治疗转移性结直肠癌的临床研究. 中华临床医师杂志(电子版), 2013, 7(17): 76-79.
21. 尚品杰. 奥沙利铂或伊立替康联合卡培他滨治疗晚期转移性肠癌的临床疗效及安全性评价. 中国临床药理学杂志, 2015, 31(24): 2396-2398.
22. 孙慧琼, 薛立光, 杜丽坤. 伊立替康/奥沙利铂联合卡培他滨治疗晚期结肠癌的疗效比较. 中外医疗, 2016, 35(19): 152-153.
23. 张学良, 王健, 徐爱兵. 奥沙利铂联合卡培他滨与伊立替康联合卡培他滨治疗晚期大肠癌的临床比较. 齐齐哈尔医学院学报, 2011, 32(13): 2097-2098.
24. 郑涛, 陈熙. 伊立替康或奥沙利铂联合卡培他滨治疗结直肠癌伴肝转移. 中国继续医学教育, 2018, 10(10): 133-134.
25. 周俊翔, 余文韬, 徐珽. 卡培他滨联合奥沙利铂治疗转移性结直肠癌的系统评价. 厦门: 《医院处方分析合作项目》全国年会, 2012.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of capecitabine combined with irinotecan versus capecitabine combined with oxaliplatin in treatment of advanced/metastatic colorectal cancer: a systematic review

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