Department of Colorectal Surgery, Shanxi Cancer Hospital, Taiyuan, Shanxi 030013, China.
Chin Med J (Engl). 2010 Nov;123(22):3314-8.
To compare clinical efficacy and toxicity of irinotecan combined with 5-fluorouracil and leucovorin with those of oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer.
Literature search was performed by keywords "irinotecan", "oxaliplatin" and "colorectal cancer" on all randomized controlled trails reported on irinotecan versus oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer in MEDLINE, OVID, Springer, Cochrane Controlled Trials Register (CCTR) and CBMdisc (Chinese Biology and Medicine disc) before January 2010. Two authors drew the details of trial design, characteristics of patients, outcomes, and toxicity from the studies included. Data analysis was performed by RevMan 4.2.
According to the screening criteria, 7 clinical studies with 2095 participants of advanced colorectal cancer were included in this meta analysis. The baseline characteristics of irinotecan group were similar to those of oxaliplatin group. The response rate of oxaliplatin group was higher than that of irinotecan group (relative risk (RR) = 0.82, 95% confidence interval (95%CI) (0.70, 0.96), P = 0.01), and the median overall survival of oxaliplatin group was longer by 2.04 months than that of irinotecan group (95%CI (-3.54, -0.54), P = 0.008). In the comparison of grade 3 - 4 toxicity between the two groups, the incidences of nausea, emesis, diarrhoea and alopecia in irinotecan group were higher than those in oxaliplatin group (RR = 1.94, 95%CI (1.22, 3.09), P = 0.005; 1.71, 95%CI (1.34, 2.18), P < 0.001; 14.56, 95%CI (4.11, 51.66), P < 0.0001), respectively. However, the incidence of neurotoxicity, neutropenia and thrombocytopenia in irinotecan group were lower than those in oxaliplatin group (RR = 0.06, 95%CI (0.03, 0.14), P < 0.00001; 0.70, 95%CI (0.55, 0.91), P = 0.006; 0.18, 95%CI (0.05, 0.61), P = 0.006), respectively.
Both irinotecan and oxaliplatin combined with 5-fluorouracil and leucovorin were effective in the first-line therapy of advanced colorectal cancer. However, the combined regimen of oxaliplatin plus 5-fluorouracil and leucovorin is more excellent. Irinotecan tended to result in more gastrointestinal tract reactions than oxaliplatin did, but the myelosuppression and neurotoxicity were more frequent in oxaliplatin regimen than irinotecan regimen.
比较伊立替康联合 5-氟尿嘧啶和亚叶酸与奥沙利铂联合 5-氟尿嘧啶和亚叶酸作为晚期结直肠癌一线治疗的临床疗效和毒性。
通过在 MEDLINE、OVID、Springer、Cochrane 对照试验注册中心（CCTR）和 CBMdisc（中国生物医学文献数据库）上以“irinotecan”、“oxaliplatin”和“colorectal cancer”为关键词对截至 2010 年 1 月所有关于伊立替康与奥沙利铂联合 5-氟尿嘧啶和亚叶酸作为晚期结直肠癌一线治疗的随机对照试验进行文献检索。两位作者从纳入的研究中提取试验设计、患者特征、结局和毒性的详细信息。数据分析采用 RevMan 4.2 进行。
根据筛选标准，纳入了 7 项包含 2095 例晚期结直肠癌患者的临床试验进行荟萃分析。伊立替康组的基线特征与奥沙利铂组相似。奥沙利铂组的缓解率高于伊立替康组（相对危险度（RR）=0.82，95%置信区间（95%CI）（0.70，0.96），P=0.01），奥沙利铂组的中位总生存期比伊立替康组长 2.04 个月（95%CI（-3.54，-0.54），P=0.008）。在两组 3-4 级毒性的比较中，伊立替康组恶心、呕吐、腹泻和脱发的发生率高于奥沙利铂组（RR=1.94，95%CI（1.22，3.09），P=0.005；1.71，95%CI（1.34，2.18），P<0.001；14.56，95%CI（4.11，51.66），P<0.0001）。然而，伊立替康组神经毒性、中性粒细胞减少和血小板减少的发生率低于奥沙利铂组（RR=0.06，95%CI（0.03，0.14），P<0.00001；0.70，95%CI（0.55，0.91），P=0.006；0.18，95%CI（0.05，0.61），P=0.006）。
伊立替康和奥沙利铂联合 5-氟尿嘧啶和亚叶酸在晚期结直肠癌的一线治疗中均有效。然而，奥沙利铂联合 5-氟尿嘧啶和亚叶酸的联合方案更具优势。伊立替康比奥沙利铂更容易导致胃肠道反应，但奥沙利铂方案的骨髓抑制和神经毒性比伊立替康方案更常见。
