Huang Yuanwei, Yu Qiuyan, Liu Yan, Zhu Zhenli, Wang Li, Wang Haidong, Li Ke
Department of Public Health, Shantou University Medical College, Shantou, Guangdong, China.
School of Public Health, Jilin Medical College, Jilin, China.
Asia Pac J Clin Oncol. 2017 Apr;13(2):e171-e178. doi: 10.1111/ajco.12456. Epub 2016 Feb 19.
Chronomodulated chemotherapy has been reported to be superior to conventional chemotherapy, but the results from randomized controlled trials (RCTs) are inconsistent. We performed a meta-analysis to summarize the efficacy and safety of chronomodulated chemotherapy for patients with metastatic colorectal cancer.
A literature search for relevant RCTs comparing the efficacy and safety of chronomodulated chemotherapy and conventional chemotherapy was performed. The main outcomes were overall survival (OS), objective response rate (ORR) and toxicity (grade 3/4), which included vomiting and nausea, diarrhea, mucositis, neutropenia and peripheral sensory neuropathy. Pooled relative risks (RRs) and hazard ratios (HRs) with their 95% confidence intervals (95% CIs) were estimated.
Six RCTs involving 1347 patients were included. Chronomodulated chemotherapy showed no advantages for OS (HR = 0.95; 95% CI, 0.84-1.08; P = 0.463) or ORR (RR = 1.06; 95% CI, 0.81-1.39; P = 0.499). The two groups were similar in terms of grade 3/4 vomiting and nausea (RR = 1.02; 95% CI, 0.78-1.35; P = 0.872), diarrhea (RR = 1.44; 95% CI, 0.87-2.36; P = 0.149) or peripheral sensory neuropathy (RR = 0.86; 95% CI, 0.56-1.34; P = 0.512), whereas decreased risks of mucositis (RR = 0.31; 95% CI, 0.14-0.66; P = 0.000) and neutropenia (RR = 0.40; 95% CI, 0.27-0.57; P = 0.000) were observed in chronomodulated chemotherapy.
Chronomodulated chemotherapy may be favorable to reduce the risks of certain side effects, but there is no current evidence for improvement in OS or ORR. Our analysis suggests that the available data does not support the use of chronomodulated chemotherapy.
有报道称时辰调节化疗优于传统化疗，但随机对照试验（RCT）的结果并不一致。我们进行了一项荟萃分析，以总结时辰调节化疗对转移性结直肠癌患者的疗效和安全性。
对比较时辰调节化疗与传统化疗疗效和安全性的相关RCT进行文献检索。主要结局指标为总生存期（OS）、客观缓解率（ORR）和毒性（3/4级），毒性包括呕吐、恶心、腹泻、黏膜炎、中性粒细胞减少和周围感觉神经病变。估计合并相对危险度（RRs）和风险比（HRs）及其95%置信区间（95% CIs）。
纳入6项RCT，共1347例患者。时辰调节化疗在OS（HR = 0.95；95% CI，0.84 - 1.08；P = 0.463）或ORR（RR = 1.06；95% CI，0.81 - 1.39；P = 0.499）方面无优势。两组在3/4级呕吐和恶心（RR = 1.02；95% CI，0.78 - 1.35；P = 0.872）、腹泻（RR = 1.44；95% CI，0.87 - 2.36；P = 0.149）或周围感觉神经病变（RR = 0.86；95% CI，0.56 - 1.34；P = 0.512）方面相似，而时辰调节化疗组黏膜炎（RR = 0.
