Rudong People's Hospital / Affiliated Rudong Hospital of Xinglin College, Nantong University, Nantong, Jiangsu, 226400, China.
Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
BMC Cancer. 2024 Jul 24;24(1):893. doi: 10.1186/s12885-024-12662-3.
To evaluate the safety of first-line systemic therapy for metastatic colorectal cancer through network meta-analysis.
The literature from PubMed, Embase, Web of Science, and Cochrane Library databases was searched from the inception of the databases to August 15, 2023, and strict inclusion and exclusion criteria were applied to screen studies. The Cochrane Bias Risk Assessment Tool (RoB 2.0) was used to evaluate the quality of the included literature. Network meta-analysis was conducted using Stata 15.0 and R4.3.1 software to compare the incidence of adverse events (AEs) among different treatment regimens.
A total of 53 randomized controlled trials, involving 17,351 patients with metastatic colorectal cancer (mCRC), were ultimately included, encompassing 29 different therapeutic approaches. According to SUCRA rankings, the CAPOX regimen is most likely to rank first in terms of safety, while the FOLFOXIRI + panitumumab regimen is most likely to rank last. In terms of specific AEs, the CAPOX regimen, whether used alone or in combination with targeted drugs (bevacizumab and cetuximab), is associated with a reduced risk of neutropenia and febrile neutropenia, as well as an increased risk of thrombocytopenia and diarrhea. The FOLFOX regimen, with or without bevacizumab, is linked to an increased risk of neutropenia and peripheral sensory neuropathy. The FOLFIRI/CAPIRI + bevacizumab regimen is associated with a reduced risk of peripheral sensory neuropathy. S-1 and S-1 + oxaliplatin are well-tolerated in terms of gastrointestinal reactions. The FOLFOXIRI regimen, whether used alone or in combination with targeted drugs, is associated with various AEs.
In summary, the CAPOX regimen may be the safest option among the first-line systemic treatment regimens for mCRC patients, while the FOLFOXIRI + panitumumab regimen may be associated with a higher incidence of grade 3 or higher AEs.
通过网络荟萃分析评估转移性结直肠癌一线系统治疗的安全性。
从数据库创建到 2023 年 8 月 15 日，检索 PubMed、Embase、Web of Science 和 Cochrane Library 数据库中的文献，并应用严格的纳入和排除标准筛选研究。使用 Cochrane 偏倚风险评估工具（RoB 2.0）评估纳入文献的质量。使用 Stata 15.0 和 R4.3.1 软件进行网络荟萃分析，比较不同治疗方案不良反应（AE）的发生率。
共纳入 53 项随机对照试验，涉及 17351 例转移性结直肠癌（mCRC）患者，共包含 29 种不同的治疗方法。根据 SUCRA 排名，CAPOX 方案在安全性方面最有可能排名第一，而 FOLFOXIRI+panitumumab 方案最有可能排名最后。在特定的 AE 方面，CAPOX 方案，无论是单独使用还是与靶向药物（贝伐珠单抗和西妥昔单抗）联合使用，均与中性粒细胞减少和发热性中性粒细胞减少风险降低相关，而与血小板减少和腹泻风险增加相关。FOLFOX 方案，无论是否联合贝伐珠单抗，均与中性粒细胞减少和周围感觉神经病变风险增加相关。FOLFIRI/CAPIRI+贝伐珠单抗方案与周围感觉神经病变风险降低相关。S-1 和 S-1+奥沙利铂在胃肠道反应方面具有良好的耐受性。FOLFOXIRI 方案，无论单独使用还是与靶向药物联合使用，均与各种 AE 相关。
综上所述，CAPOX 方案可能是 mCRC 患者一线系统治疗方案中最安全的选择，而 FOLFOXIRI+panitumumab 方案可能与更高的 3 级或更高级别的 AE 发生率相关。
