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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Abstract Full text Figures/Tables Video References Cited by

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, 劉振洋, 等. mFOLFOX6方案與CapeOX方案治療老年轉移性結直腸癌臨床療效分析. 實用臨床醫藥雜志, 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, 余文韜, 徐珽, 等. XELOX方案與FOLFOX方案治療轉移性結直腸癌的系統評價. 中國藥房, 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.	李文樺, 張文. 晚期結直腸癌的化療進展. 中國癌癥雜志, 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.	孟憲祿, 樊青霞, 王春燕. 伊立替康聯合卡培他濱在晚期直腸癌的臨床療效觀察. 醫藥論壇雜志, 2013, 34(5): 52-53, 56.
12.	楊瑞萍, 安艷海, 黎盼盼, 等. 伊立替康聯合卡培他濱治療晚期結直腸癌68例臨床觀察. 內科, 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, 劉承偉, 等. 伊立替康或奧沙利鉑聯合卡培他濱治療結直腸癌伴肝轉移的臨床研究. 中國腫瘤臨床, 2014, 41(9): 593-596.
17.	李大鵬, 任紅, 李建柱. 奧沙利鉑聯合卡培他濱方案和伊立替康聯合卡培他濱方案一線治療K-ras突變型結直腸癌的療效對比分析. 中國臨床醫生雜志, 2016, 44(12): 72-75.
18.	劉崇遠, 呂魯閩, 徐寶康. 卡培他濱聯合奧沙利鉑或伊立替康治療轉移性結直腸癌的療效與安全性. 中國臨床藥理學雜志, 2014, 30(10): 907-908, 918.
19.	劉慧燕, 張斌. 奧沙利鉑或伊立替康聯合卡培他濱治療晚期結直腸癌的臨床研究. 中國臨床藥理學雜志, 2013, 29(4): 243-245.
20.	羅秦英, 羅敏娜, 唐露, 等. 奧沙利鉑或伊立替康聯合卡培他濱治療轉移性結直腸癌的臨床研究. 中華臨床醫師雜志(電子版), 2013, 7(17): 76-79.
21.	尚品杰. 奧沙利鉑或伊立替康聯合卡培他濱治療晚期轉移性腸癌的臨床療效及安全性評價. 中國臨床藥理學雜志, 2015, 31(24): 2396-2398.
22.	孫慧瓊, 薛立光, 杜麗坤. 伊立替康/奧沙利鉑聯合卡培他濱治療晚期結腸癌的療效比較. 中外醫療, 2016, 35(19): 152-153.
23.	張學良, 王健, 徐愛兵. 奧沙利鉑聯合卡培他濱與伊立替康聯合卡培他濱治療晚期大腸癌的臨床比較. 齊齊哈爾醫學院學報, 2011, 32(13): 2097-2098.
24.	鄭濤, 陳熙. 伊立替康或奧沙利鉑聯合卡培他濱治療結直腸癌伴肝轉移. 中國繼續醫學教育, 2018, 10(10): 133-134.
25.	周俊翔, 余文韜, 徐珽. 卡培他濱聯合奧沙利鉑治療轉移性結直腸癌的系統評價. 廈門: 《醫院處方分析合作項目》全國年會, 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, 劉振洋, 等. mFOLFOX6方案與CapeOX方案治療老年轉移性結直腸癌臨床療效分析. 實用臨床醫藥雜志, 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, 余文韜, 徐珽, 等. XELOX方案與FOLFOX方案治療轉移性結直腸癌的系統評價. 中國藥房, 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. 李文樺, 張文. 晚期結直腸癌的化療進展. 中國癌癥雜志, 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. 孟憲祿, 樊青霞, 王春燕. 伊立替康聯合卡培他濱在晚期直腸癌的臨床療效觀察. 醫藥論壇雜志, 2013, 34(5): 52-53, 56.
12. 楊瑞萍, 安艷海, 黎盼盼, 等. 伊立替康聯合卡培他濱治療晚期結直腸癌68例臨床觀察. 內科, 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, 劉承偉, 等. 伊立替康或奧沙利鉑聯合卡培他濱治療結直腸癌伴肝轉移的臨床研究. 中國腫瘤臨床, 2014, 41(9): 593-596.
17. 李大鵬, 任紅, 李建柱. 奧沙利鉑聯合卡培他濱方案和伊立替康聯合卡培他濱方案一線治療K-ras突變型結直腸癌的療效對比分析. 中國臨床醫生雜志, 2016, 44(12): 72-75.
18. 劉崇遠, 呂魯閩, 徐寶康. 卡培他濱聯合奧沙利鉑或伊立替康治療轉移性結直腸癌的療效與安全性. 中國臨床藥理學雜志, 2014, 30(10): 907-908, 918.
19. 劉慧燕, 張斌. 奧沙利鉑或伊立替康聯合卡培他濱治療晚期結直腸癌的臨床研究. 中國臨床藥理學雜志, 2013, 29(4): 243-245.
20. 羅秦英, 羅敏娜, 唐露, 等. 奧沙利鉑或伊立替康聯合卡培他濱治療轉移性結直腸癌的臨床研究. 中華臨床醫師雜志(電子版), 2013, 7(17): 76-79.
21. 尚品杰. 奧沙利鉑或伊立替康聯合卡培他濱治療晚期轉移性腸癌的臨床療效及安全性評價. 中國臨床藥理學雜志, 2015, 31(24): 2396-2398.
22. 孫慧瓊, 薛立光, 杜麗坤. 伊立替康/奧沙利鉑聯合卡培他濱治療晚期結腸癌的療效比較. 中外醫療, 2016, 35(19): 152-153.
23. 張學良, 王健, 徐愛兵. 奧沙利鉑聯合卡培他濱與伊立替康聯合卡培他濱治療晚期大腸癌的臨床比較. 齊齊哈爾醫學院學報, 2011, 32(13): 2097-2098.
24. 鄭濤, 陳熙. 伊立替康或奧沙利鉑聯合卡培他濱治療結直腸癌伴肝轉移. 中國繼續醫學教育, 2018, 10(10): 133-134.
25. 周俊翔, 余文韜, 徐珽. 卡培他濱聯合奧沙利鉑治療轉移性結直腸癌的系統評價. 廈門: 《醫院處方分析合作項目》全國年會, 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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