• 四川大學(xué)（成都，610041）1華西醫(yī)院藥劑科，2華西藥學(xué)院;

目的 　評價(jià)卡培他濱+伊立替康與氟尿嘧啶/醛氫葉酸（5-FU/LV）+伊立替康治療轉(zhuǎn)移性結(jié)直腸癌的有效性和安全性。 方法　 計(jì)算機(jī)檢索PubMed、CENTRAL、Embase、中國生物醫(yī)學(xué)數(shù)據(jù)庫、中國期刊全文數(shù)據(jù)庫、維普數(shù)據(jù)庫和萬方數(shù)據(jù)庫，檢索時(shí)間均從建庫至2011年9月。對符合納入標(biāo)準(zhǔn)的隨機(jī)對照試驗(yàn)進(jìn)行質(zhì)量評價(jià)和Meta分析。 結(jié)果 　納入3個(gè)隨機(jī)對照試驗(yàn)，共計(jì)419例患者，卡培他濱+伊立替康在中位生存期、完全緩解率[RR=1.58，95%CI（0.27，9.11），P=0.61]、部分緩解率[RR=0.86，95%CI（0.68，1.09），P=0.20]、總有效率[RR=0.88，95%CI（0.71，1.09），P=0.26]上表現(xiàn)出與5-FU/LV+伊立替康相似的效果，安全性方面卡培他濱+伊立替康有較高的Ⅲ/Ⅳ級惡心[RR=1.92，95%CI（1.05，3.54），P=0.04]、腹瀉[RR=3.23，95%CI（2.14，4.89），P＜0.000 01]發(fā)生風(fēng)險(xiǎn)和較低的Ⅲ/Ⅳ級中性粒細(xì)胞減少[RR=0.72，95%CI（0.53，0.98），P=0.04]發(fā)生風(fēng)險(xiǎn)。 結(jié)論 　根據(jù)當(dāng)前現(xiàn)有證據(jù)，5-FU/LV+伊立替康可能較卡培他濱+伊立替康更為有利于轉(zhuǎn)移性結(jié)直腸癌患者的治療，但仍需結(jié)合臨床實(shí)際情況進(jìn)行化療方案的優(yōu)選。

引用本文： 周俊翔,蔣學(xué)華,徐珽,唐堯. 卡培他濱聯(lián)合伊立替康治療轉(zhuǎn)移性結(jié)直腸癌的Meta分析. 華西醫(yī)學(xué), 2012, 27(5): 687-692. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《華西醫(yī)學(xué)》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. 　Benson AB 3rd. New approaches to the adjuvant therapy of colon cancer[J]. Oncologist, 2006, 11(9): 973-980.
2. 　Saltz LB. Adjuvant therapy for colon cancer[J]. Surg Oncol Clin N Am, 2010, 19(4): 819-827.
3. 　王艇, 羅黎力, 周清華, 等. 奧沙利鉑聯(lián)合5-FU/LV與伊立替康聯(lián)合5-FU/LV比較治療晚期結(jié)直腸癌的系統(tǒng)評價(jià)[J]. 中國循證醫(yī)學(xué)雜志, 2008, 8(1): 36-41.
4. 　Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage Ⅲ colon cancer[J]. N Engl J Med, 2005, 352(26): 2696-2704.
5. 　Twelves C, Gollins S, Grieve R, et al. A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer[J]. Ann Oncol, 2006, 17(2): 239-245.
6. 　Koukourakis GV, Kouloulias V, Koukourakis MJ, et al. Efficacy of the oral fluorouracil pro-drug capecitabine in cancer treatment: a review[J]. Molecules, 2008, 13(8): 1897-1922.
7. 　Walko CM, Lindley C. Capecitabine: a review[J]. Clin Ther, 2005, 27(1): 23-44.
8. 　Haller DG, Tabernero J, Maroun J, et al. Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stageⅢ colon cancer[J]. J Clin Oncol, 2011, 29(11): 1465-1471.
9. 　Hsu TC, Chen HH, Yang MC, et al. Pharmacoeconomic analysis of capecitabine versus 5-fluorouracil/leucovorin as adjuvant therapy for stage Ⅲ colon cancer in Taiwan[J]. Value Health, 2011, 14(5): 647-651.
10. 　Borner MM, Bernhard J, Dietrich D, et al. A randomized phaseⅡ trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity[J]. Ann Oncol, 2005, 16(2): 282-288.
11. 　Patt YZ, Lee FC, Liebmann JE, et al. Capecitabine plus 3-weekly irinotecan (XELIRI regimen) as first-line chemotherapy for metastatic colorectal cancer: phaseⅡ trial results[J]. Am J Clin Oncol, 2007, 30(4): 350-357.
12. 　Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, et al. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group[J]. Br J Cancer, 2009, 101(7): 1039-1043.
13. 　Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions Version 5.0.0[updated February 2008][EB/OL]. The Cochrane Collaboration, 2008. http://www.mrc-bsu.cam.ac.uk/cochrane/handbook500/.
14. 　Skof E, Rebersek M, Hlebanja Z, et al. Capecitabine plus Irinotecan (XELIRI regimen) compared to 5-FU/LV plus Irinotecan (FOLFIRI regimen) as neoadjuvant treatment for patients with unresectable liver-only metastases of metastatic colorectal cancer: a randomised prospective phase Ⅱ trial[J]. BMC Cancer, 2009, 9(9): 120.
15. 　Fuchs CS, Marshall J, Barrueco J. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: updated results from the BICC-C study[J]. J Clin Oncol, 2008, 26(4): 689-690.
16. 　Köhne CH, De Greve J, Hartmann JT, et al. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015[J]. Ann Oncol, 2008, 19(5): 920-926.
17. 　Toxicity of fluorouracil in patients with advanced colorectal cancer:effect of administration schedule, factors P. Meta-Analysis group in cancer[J]. J Clin Oncol, 1998, 16(11): 3537-3541.
18. 　Zhang RX, Wu XJ, Lu SX, et al. The effect of COX-2 inhibitor on capecitabine-induced hand-foot syndrome in patients with stageⅡ/Ⅲ colorectal cancer: a phaseⅡ randomized prospective study[J]. J Cancer Res Clin Oncol, 2011, 137(6): 953-957.
19. 　Kamil M, Haron M, Yosuff N, et al. High frequency of hand foot syndrome with capecitabine[J]. J Coll Physicians Surg Pak, 2010, 20(6): 421-422.
  1. 1. 　Benson AB 3rd. New approaches to the adjuvant therapy of colon cancer[J]. Oncologist, 2006, 11(9): 973-980.
  2. 2. 　Saltz LB. Adjuvant therapy for colon cancer[J]. Surg Oncol Clin N Am, 2010, 19(4): 819-827.
  3. 3. 　王艇, 羅黎力, 周清華, 等. 奧沙利鉑聯(lián)合5-FU/LV與伊立替康聯(lián)合5-FU/LV比較治療晚期結(jié)直腸癌的系統(tǒng)評價(jià)[J]. 中國循證醫(yī)學(xué)雜志, 2008, 8(1): 36-41.
  4. 4. 　Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage Ⅲ colon cancer[J]. N Engl J Med, 2005, 352(26): 2696-2704.
  5. 5. 　Twelves C, Gollins S, Grieve R, et al. A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer[J]. Ann Oncol, 2006, 17(2): 239-245.
  6. 6. 　Koukourakis GV, Kouloulias V, Koukourakis MJ, et al. Efficacy of the oral fluorouracil pro-drug capecitabine in cancer treatment: a review[J]. Molecules, 2008, 13(8): 1897-1922.
  7. 7. 　Walko CM, Lindley C. Capecitabine: a review[J]. Clin Ther, 2005, 27(1): 23-44.
  8. 8. 　Haller DG, Tabernero J, Maroun J, et al. Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stageⅢ colon cancer[J]. J Clin Oncol, 2011, 29(11): 1465-1471.
  9. 9. 　Hsu TC, Chen HH, Yang MC, et al. Pharmacoeconomic analysis of capecitabine versus 5-fluorouracil/leucovorin as adjuvant therapy for stage Ⅲ colon cancer in Taiwan[J]. Value Health, 2011, 14(5): 647-651.
  10. 10. 　Borner MM, Bernhard J, Dietrich D, et al. A randomized phaseⅡ trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity[J]. Ann Oncol, 2005, 16(2): 282-288.
  11. 11. 　Patt YZ, Lee FC, Liebmann JE, et al. Capecitabine plus 3-weekly irinotecan (XELIRI regimen) as first-line chemotherapy for metastatic colorectal cancer: phaseⅡ trial results[J]. Am J Clin Oncol, 2007, 30(4): 350-357.
  12. 12. 　Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, et al. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group[J]. Br J Cancer, 2009, 101(7): 1039-1043.
  13. 13. 　Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions Version 5.0.0[updated February 2008][EB/OL]. The Cochrane Collaboration, 2008. http://www.mrc-bsu.cam.ac.uk/cochrane/handbook500/.
  14. 14. 　Skof E, Rebersek M, Hlebanja Z, et al. Capecitabine plus Irinotecan (XELIRI regimen) compared to 5-FU/LV plus Irinotecan (FOLFIRI regimen) as neoadjuvant treatment for patients with unresectable liver-only metastases of metastatic colorectal cancer: a randomised prospective phase Ⅱ trial[J]. BMC Cancer, 2009, 9(9): 120.
  15. 15. 　Fuchs CS, Marshall J, Barrueco J. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: updated results from the BICC-C study[J]. J Clin Oncol, 2008, 26(4): 689-690.
  16. 16. 　Köhne CH, De Greve J, Hartmann JT, et al. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015[J]. Ann Oncol, 2008, 19(5): 920-926.
  17. 17. 　Toxicity of fluorouracil in patients with advanced colorectal cancer:effect of administration schedule, factors P. Meta-Analysis group in cancer[J]. J Clin Oncol, 1998, 16(11): 3537-3541.
  18. 18. 　Zhang RX, Wu XJ, Lu SX, et al. The effect of COX-2 inhibitor on capecitabine-induced hand-foot syndrome in patients with stageⅡ/Ⅲ colorectal cancer: a phaseⅡ randomized prospective study[J]. J Cancer Res Clin Oncol, 2011, 137(6): 953-957.
  19. 19. 　Kamil M, Haron M, Yosuff N, et al. High frequency of hand foot syndrome with capecitabine[J]. J Coll Physicians Surg Pak, 2010, 20(6): 421-422.