CRC: low-dose leucovorin offers similar response, survival in meta-analysis

  • Hsu CY & al.
  • Colorectal Dis
  • 1 Jul 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis shows similar efficacy and a lower incidence of diarrhea associated with a low dose of leucovorin compared with the standard dose in the treatment of colorectal cancer (CRC).

Why this matters

  • Observational and clinical studies of high- vs low-dose leucovorin have yielded inconsistent results.

Study design

  • Meta-analysis of 8 randomized controlled trials and 4 retrospective studies.
  • Funding: Taipei Medical University.

Key results

  • High doses were 200-500 mg/m2. Lower doses were 20-50 mg/m2.
  • The pooled standard mean difference in median survival time favored high-dose leucovorin but failed to reach statistical significance (−0.06; 95% CI, −0.19 to 0.08).
  • 3-year OS was similar among 4927 patients with stage I-III CRC (OR, 1.04; P=.43).
  • Pooled tumor response rate favored high-dose leucovorin but the difference was not statistically significant (OR, 0.81; 95% CI, 0.55-1.18).
  • There was no significant difference in hematologic toxicities, nausea, vomiting, or mucositis.
  • The low-dose group had a lower incidence of grade 3-4 diarrhea (OR, 0.62; 95% CI, 0.47-0.82).

Limitations

  • The included studies could have selection biases.

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