Rectal cancer: capecitabine tops 5-FU in neoadjuvant chemoradiation

  • Zhu J & al.
  • Medicine (Baltimore)
  • 1 Apr 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis shows that neoadjuvant chemoradiotherapy (CRT) using a capecitabine-based regimen led to better pathological complete response, nodal downstaging, and R0 resection rates than 5-fluorouracil (5-FU) in patients with locally advanced rectal cancer.  

Why this matters

  • The comparative efficacy of capecitabine and 5-FU has not been well established in this setting.

Study design

  • Meta-analysis of 10 studies (n=2916) analyzing the effect of capecitabine and 5-FU on neoadjuvant CRT.
  • Funding: None disclosed.

Key results

  • Pathologic complete response was higher with capecitabine (19.53% vs 15.48%; OR, 1.34; P=.004).
  • No significant difference in overall downstaging or tumor downstaging rate, but capecitabine was associated with a higher rate of nodal downstaging (66.36% vs 56.03%; OR, 1.68; P=.01).
  • Capecitabine yielded a higher R0 resection rate (87.86% vs 80.10%; OR, 1.92; P=.02; number needed to treat, 13).
  • No significant between-group difference with respect to sphincter preservation, 3-year DFS, grade 3/4 acute toxicity during CRT or neoadjuvant CRT, perioperative mortality, or anastomotic leakage.

Limitations

  • Only 2 studies were randomized.

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