Doublet (FOLFOX or FOLFIRI) versus triplet (FOLFOXIRI) backbone chemotherapy regimen as first-line treatment of metastatic colorectal cancer: A meta-analysis and systematic review.

Authors

null

Vishal Jindal

Beaumont Health, Department of Hematology and Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI

Vishal Jindal , Ruby Gupta , Kamal Kant Sahu , Mandeep Singh Rahi , Michael J. Stender , Ishmael A. Jaiyesimi

Organizations

Beaumont Health, Department of Hematology and Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, St. Vincent Hospital, Worcester, MA, Bridgeport Hospital, Bridgeport, CT

Research Funding

No funding received
None

Background: Doublet chemotherapy FOLFOX and FOLFIRI are standard for first‐line treatment of metastatic colorectal cancer (mCRC). Recently, use of triplet chemotherapy FOLFOXIRI has shown an increased anti-cancer activity but still there is uncertainty regarding first line backbone chemotherapy. Therefore, we conducted this metanalysis to determine the efficacy, safety and outcome of triplet vs doublet chemotherapy. Methods: The study protocol was published at PROSPERO (CRD42020166745) and prepared as per PRISMA guidelines. Total 10 studies were included, with sample size of 1536 participants in triplet arm and 1535 participants in doublet arm. The primary outcome is Response rate (RR) and secondary outcomes are Progression-free survival (PFS), Overall survival (OS), post chemotherapy radical (R0) surgical resection rate of metastases. Quantitative synthesis was performed using “R” statistical package. Dichotomous outcomes were summarized using odds ratio (OR) and time to event data was summarized using hazard ratio (HR). Results: A total of 678 articles were retrieved. The Medline article search gave a result of 271 article, Embase 296, the Cochrane Library 100 and Clinical tral.gov 11, when searched through April 2020. Total 10 studies were included. All the studies were randomized, open-label, multicenter study. Out of the 10 trials 5 each were phase II and phase III studies. The pooled odds ratio for RR was 1.66 (95% CI 1.42 to 1.93) and PFS was (HR, 0.70; 95% CI, 0.63–0.78) in favor of triplet chemotherapy. There was significant improvement in radical resection (R0) of metastases (OR 1.59; 95% CI, 1.27–1.98) in triplet arm. Triplet arm was also associated with increased toxicity especially neurological events 2.51(0.88-7.16), diarrhea 2.40(1.74-3.31), neutropenia, 2.23(1.71-2.90) and thrombocytopenia 1.94(1.05-3.59). Conclusions: Findings in this meta-analysis showed that FOLFOXIRI significantly improves the PFS, RR, OS, and R0 resection rate of overall metastases over the doublet chemotherapy. The incidence of fatal adverse events was found to be more in triplet chemotherapy compared to doublet therapy. Therefore, we concluded that with moderate evidence FOLFOXIRI provide clinically meaningful efficacy benefit at cost of increased toxicity.

Outcome
Odds ratio (OR)/Hazard ratio(HR) (95% Confidence interval)
Number of studies
Number of participants
I2 Value (%)
OS
HR - 0.81(0.73-0.89)
7
2235
0
PFS
HR - 0.70(0.63-0.78)
8
2568
19
RR
OR -1.66 (1.42-1.93)
10
2815
0
R0 Resection Rate
OR- 1.59 (1.27-1.98)
10
2834
0
Neurological events
OR- 2.51(0.88-7.16)
9
2578
44
Diarrhea
OR- 2.40(1.74-3.31)
9
2578
54
Neutropenia
OR- 2.23(1.71-2.90)
9
2578
0
Thrombocytopenia
OR- 1.94(1.05-3.59)
7
2149
69
Mucositis
OR- 1.68(1.35-2.10)
9
2498
91

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 3593)

DOI

10.1200/JCO.2021.39.15_suppl.3593

Abstract #

3593

Poster Bd #

Online Only

Abstract Disclosures