XELOX Versus FOLFOX As An Treatment For Metastatic Colorectal Cancer In Terms Of Efficacy And Safety: A Meta Analysis

Objectives:The paper aims to evaluate chemotherapy with XELOX(Capecitabine plus oxaliplatin) versus FOLXOX (fluorouracil plusoxaliplatin) as treatment for metastatic colorectal cancer in terms ofefficacy and safety. A cost analysis on XELOX and FOLFOX is alsoconducted to provide basis for the clinical application of XELOX andFOLFOX.Methods:A total of4363patients from eight randomized controlledtrials were available for analysis:2194patients in capecitabine (CAP) plusoxaliplatin group and2169patients in fluorouracil (FU) plus oxaliplatingroup. The efficacy data including overall survival (OS), progression freesurvival (PFS), overall response rate (ORR), and the safety data containinguntoward effect such as anaemia, thrombocytopenia, neutropenia, diarrhoea,nausea, asthenia, vomiting, abdominal pain, hand foot syndrome,neuropathy and stomatitis were evaluated.4controlled clinical trials wereanalyzed to compare the cost of XELOX and FOLFOX.Results:Pooled analysis of OS (odds ratio OR=1.04,95%CI:0.90–1.20, P=0.56), PFS (OR=0.96,95%CI:0.80–1.15, P=0.63), ORR (OR=0.92,95%CI:0.81–1.04,P=0.16) in the capecitabine plusoxaliplatin group shows no statistical significance when compared withthose in the FU plus oxaliplatin group. The statistically significantdifferences in pooled estimates suggested a higher incidence of grade34thrombocytopenia (OR=1.86,1.31–2.65, P=0.0005), grade34hand-footsyndrome(OR=4.12,2.40–7.10, P <0.00001) in the CAP plus oxaliplatingroup while in the FU plus oxaliplatin group grade34neutropenia (OR=0.14,0.11–0.17, P <0.00001) showed a higher incidence. No statisticallysignificant difference was noted in the incidence of grade34anaemia,asthenia, diarrhoea, nausea, vomiting, abdominal pain, neuropathy andstomatitis. The cost analysis indicated that compared with FOLFOX,XELOX cost considerably less in aspects of hospitalization expense, timesand length of stay.Conclusion:For metastatic colorectal cancer, the effect of CAP plusoxaliplatin regimen is similar to FU plus oxaliplatin regimen, but in termsof convenience to administer and cost analysis XELOX shows moreadvantages over FOLFOX.