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Meta-Analysis:

Network metaanalysis of the efficacy of firstline chemotherapy regimens in patients with advanced colorectal cancer

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Oncotarget. 2017; 8:100668-100677. https://doi.org/10.18632/oncotarget.22177

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Dong-Mei Wu1, Yong-Jian Wang1, Shao-Hua Fan1, Juan Zhuang1,2,3, Zi-Feng Zhang1, Qun Shan1, Xin-Rui Han1, Xin Wen1, Meng-Qiu Li1, Bin Hu1, Chun-Hui Sun1, Ya-Xing Bao4, Hai-Juan Xiao5, Lin Yang6, Jun Lu1 and Yuan-Lin Zheng1

1Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China

2School of Environment Science and Spatial Informatics, China University of Mining and Technology, Xuzhou 221008, P.R. China

3Jiangsu Key Laboratory for Eco-Agricultural Biotechnology around Hongze Lake, School of Life Sciences, Huaiyin Normal University, Huaian 223300, P.R. China

4Department of Orthopaedics, The Affiliated Municipal Hospital of Xuzhou Medical University, Xuzhou 221009, P.R. China

5Department of Oncology, Hospital Affiliated to Shaanxi University of Chinese Medicine, Xianyang 712000, P.R. China

6Department of Hepatobiliary Surgery, Xianyang Central Hospital, Xianyang 712000, P.R. China

Correspondence to:

Jun Lu, email: [email protected]

Yuan-Lin Zheng, email: [email protected]

Keywords: advanced colorectal cancer; chemotherapy; efficacy; randomized controlled trial; bayesian network model

Received: February 21, 2017     Accepted: October 13, 2017     Published: October 31, 2017

ABSTRACT

This network meta-analysis compared the short-term and long-term efficacies of first-line chemotherapy regimens in patients with advanced colorectal cancer (CRC). The 10 regimens included folinic acid + 5-fluorouracil + oxaliplatin (FOLFOX), folinic acid + 5-fluorouracil + irinotecan (FOLFIRI), folinic acid + 5-fluorouracil + gemcitabine (FFG), folinic acid + 5-fluorouracil + trimetrexate (FFT), folinic acid + 5-fluorouracil (FF), irinotecan + oxaliplatin (IROX), raltitrexed + oxaliplatin (TOMOX), folinic acid + tegafur-uracil (FTU), raltitrexed, and capecitabine. Electronic searches were performed in the Cochrane Library, PubMed and Embase databases from inception to June 2017. Network meta-analysis combined direct and indirect evidence to obtain odds ratios (ORs) and surface under the cumulative ranking curves (SUCRA) of different chemotherapy regimens for advanced CRC. Fourteen randomized controlled trails (RCTs) covering 4,383 patients with advanced CRC were included. The results revealed that FOLFOX, FOLFIRI, IROX, and TOMOX all showed higher overall response rates (ORRs) than FF or raltitrexed. Compared with raltitrexed, the aforementioned four regimens also had higher 1-year progression-free survival (PFS) rates. In addition, FOLFOX and FOLFIRI exhibited higher disease control rates (DCRs) and 1-year PFS rates than FF or raltitrexed. Cluster analysis revealed that FOLFOX, FOLFIRI, and TOMOX had better short-term and long-term efficacies. These findings suggest FOLFOX, FOLFIRI, and TOMOX are superior to other regimens for advanced CRC. These three regimens are therefore recommended for clinical treatment of advanced CRC.