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Title: Triplet (FOLFOXIRI) versus doublet (FOLFOX or FOLFIRI) backbone chemotherapy as first-line treatment of metastatic colorectal cancer : a systematic review and meta-analysis
Author: Marques, Rui Pedro
Duarte, Gonçalo S.
Sterrantino, Carmelo
Pais, Helena Luna
Quintela, António
Martins, Ana Paula
Costa, João
Keywords: Metastatic colorectal cancer
Triplet chemotherapy
Doublet chemotherapy
Issue Date: 2017
Publisher: Elsevier
Citation: Critical Reviews in Oncology / Hematology 118 (2017) 54–62
Abstract: Uncertainty exists regarding the comparative effectiveness of triplet chemotherapy (FOLFOXIRI) as backbone first-line chemotherapy for metastatic colorectal cancer (mCRC). We conducted a systematic review and meta-analysis of randomized-controlled trials (RCTs) comparing triplet versus doublet chemotherapy (FOLFOX or FOLFIRI) as first-line therapy in mCRC. Methods and reporting followed PRISMA and SAMPL guidelines. Eight RCTs were included, comprising 1732 patients. In pooled analysis, FOLFOXIRI was associated with improvements in efficacy outcomes, notably with a 25% survival increase (95%CI: 10-37%). FOLFOXIRI was also associated with increased toxicity, with a non-significant 25% increase in the risk of patients experiencing grade ≥3 adverse events (95% CI: -3 to 61%) and with a 1.83 (95% CI: 1.62-2.07) increase in the rate ratio of grade ≥3 adverse events. Moderate quality evidence suggests that first-line FOLFOXIRI provides clinically meaningful efficacy benefits in this setting, at the expense of increased toxicity. Further research is warranted to better characterize safety and to evaluate the most beneficial combination with targeted agents.
Description: © 2017 Elsevier B.V. All rights reserved.
Peer review: yes
DOI: 10.1016/j.critrevonc.2017.08.006
ISSN: 1040-8428
Publisher Version:
Appears in Collections:IMM - Artigos em Revistas Internacionais
FM-CEMBE-Artigos em Revistas Internacionais

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