Abstract
This network meta-analysis compared the short-term and long-term efficacies of first-line chemotherapy regimens in patients with advanced colorectal cancer (CRC). The 10 regimens included folinic acid + 5-fluorouracil + oxaliplatin (FOLFOX), folinic acid + 5-fluorouracil + irinotecan (FOLFIRI), folinic acid + 5-fluorouracil + gemcitabine (FFG), folinic acid + 5-fluorouracil + trimetrexate (FFT), folinic acid + 5-fluorouracil (FF), irinotecan + oxaliplatin (IROX), raltitrexed + oxaliplatin (TOMOX), folinic acid + tegafur-uracil (FTU), raltitrexed, and capecitabine. Electronic searches were performed in the Cochrane Library, PubMed and Embase databases from inception to June 2017. Network meta-analysis combined direct and indirect evidence to obtain odds ratios (ORs) and surface under the cumulative ranking curves (SUCRA) of different chemotherapy regimens for advanced CRC. Fourteen randomized controlled trails (RCTs) covering 4,383 patients with advanced CRC were included. The results revealed that FOLFOX, FOLFIRI, IROX, and TOMOX all showed higher overall response rates (ORRs) than FF or raltitrexed. Compared with raltitrexed, the aforementioned four regimens also had higher 1-year progression-free survival (PFS) rates. In addition, FOLFOX and FOLFIRI exhibited higher disease control rates (DCRs) and 1-year PFS rates than FF or raltitrexed. Cluster analysis revealed that FOLFOX, FOLFIRI, and TOMOX had better short-term and long-term efficacies. These findings suggest FOLFOX, FOLFIRI, and TOMOX are superior to other regimens for advanced CRC. These three regimens are therefore recommended for clinical treatment of advanced CRC.
Highlights
Colorectal cancer (CRC) is the most commonly diagnosed cancer and is the fourth leading cause of cancer-related deaths all over the world [1, 2]
For the remaining 2,600 articles, after detailed assessment of the full text, we excluded 631 articles on targeted therapy, 1,211 articles that were irrelevant with the advanced colorectal cancer (CRC), 743 articles that were irrelevant with chemotherapy, and 1 article with no data or insufficient data
The direct paired comparisons were performed for the short-term and long-term efficacies of 10 first-line chemotherapy regimens in the treatment of advanced CRC, and the results indicated that for overall response rates (ORRs), disease control rates (DCRs), and 1-year progressionfree survival (PFS) rate, the efficacy of folinic acid + 5-fluorouracil (FF) was poor compared with folinic acid + 5-fluorouracil + oxaliplatin (FOLFOX) (OR = 2.97, 95% confidence intervals (CIs) = 2.14–4.14; odds ratios (ORs) = 1.91, 95% CI = 1.34–2.71; OR = 2.34, 95% CI = 1.61–3.41, respectively) (Supplementary Table 1)
Summary
Colorectal cancer (CRC) is the most commonly diagnosed cancer and is the fourth leading cause of cancer-related deaths all over the world [1, 2]. According to the World Health Organization (WHO) estimates for 2030, CRC new cases will increase by 77% annually and CRC-related deaths will increase by 80% [3]. CRC is preventable with early diagnosis, and currently, medical imaging is an important modality for screening, staging, and surveillance of CRC [5]. The most often treatments of CRC can be surgical resection, adjuvant chemotherapy, and drug therapy [1]. Because of the complex structure of the pelvis, the treatment of CRC is not completed by the surgical operation, so drug-combination chemotherapy has become a common treatment of CRC [6]
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