1. Triplet (FOLFOXIRI) versus doublet (FOLFOX or FOLFIRI) backbone chemotherapy as first-line treatment of metastatic colorectal cancer: A systematic review and meta-analysis
- Author
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Rui Marques, Helena Luna Pais, Ana Paula Martins, Carmelo Sterrantino, Gonçalo S Duarte, João Costa, Antonio de Carvalho Quintela, and Repositório da Universidade de Lisboa
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,Organoplatinum Compounds ,Colorectal cancer ,medicine.medical_treatment ,Leucovorin ,Rate ratio ,03 medical and health sciences ,FOLFIRI ,0302 clinical medicine ,FOLFOX ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Humans ,Neoplasm Metastasis ,Adverse effect ,Doublet chemotherapy ,FOLFOXIRI ,Chemotherapy ,business.industry ,Metastatic colorectal cancer ,Hematology ,medicine.disease ,030104 developmental biology ,030220 oncology & carcinogenesis ,Meta-analysis ,Camptothecin ,Fluorouracil ,Triplet chemotherapy ,business ,Colorectal Neoplasms ,medicine.drug - Abstract
© 2017 Elsevier B.V. All rights reserved., Uncertainty exists regarding the comparative effectiveness of triplet chemotherapy (FOLFOXIRI) as backbone first-line chemotherapy for metastatic colorectal cancer (mCRC). We conducted a systematic review and meta-analysis of randomized-controlled trials (RCTs) comparing triplet versus doublet chemotherapy (FOLFOX or FOLFIRI) as first-line therapy in mCRC. Methods and reporting followed PRISMA and SAMPL guidelines. Eight RCTs were included, comprising 1732 patients. In pooled analysis, FOLFOXIRI was associated with improvements in efficacy outcomes, notably with a 25% survival increase (95%CI: 10-37%). FOLFOXIRI was also associated with increased toxicity, with a non-significant 25% increase in the risk of patients experiencing grade ≥3 adverse events (95% CI: -3 to 61%) and with a 1.83 (95% CI: 1.62-2.07) increase in the rate ratio of grade ≥3 adverse events. Moderate quality evidence suggests that first-line FOLFOXIRI provides clinically meaningful efficacy benefits in this setting, at the expense of increased toxicity. Further research is warranted to better characterize safety and to evaluate the most beneficial combination with targeted agents.
- Published
- 2016