Survival Benefit With Capecitabine Maintenance in Metastatic CRC

M. Alexander Otto, PA, MMS

December 07, 2022

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Capecitabine maintenance is associated with a significant improvement in progression-free survival (PFS) and overall survival compared with active monitoring after first-line treatment for patients with metastatic colorectal cancer (CRC).

Why This Matters

  • First-line treatment of metastatic CRC is often limited by cumulative side effects, leading to the need for second-line options.

  • Whether to administer maintenance therapy or use active surveillance in the second line remains controversial; although capecitabine has been shown to improve PFS, some studies have found that the benefit comes at the cost of ongoing toxicity.

  • The current study showed that among patients who received capecitabine maintenance in the second line, survival was improved, and the adverse events were manageable.

Study Design

  • The investigators performed a meta-analysis of five trials of capecitabine vs active monitoring after first-line treatment. The trials involved 1672 patients with metastatic CRC.

Key Results

  • Compared with active monitoring, capecitabine maintenance therapy was associated with a significant improvement in PFS (hazard ratio [HR], 0.59) and overall survival (HR, 0.85).

  • Capecitabine maintenance was associated with a 41% reduction in the risk of progression and a 15% reduction in the risk of death in comparison with active monitoring.

  • In a subgroup analysis, patients with BRAF/RAS wild-type mutations benefited significantly from capecitabine maintenance, but those with BRAF or RAS mutations did not.

  • The incidence of hand-foot syndrome was 2.3% with capecitabine, vs 0.4% with active monitoring (P = .01). There was no significant difference in the incidence of other grade 3/4 adverse events between the two groups.

Limitations

  • Data could not be adjusted for differences in the patients' baseline characteristics.

  • Treatment compliance data are lacking.

  • First-line treatment choices may have affected the outcomes.

Disclosures

  • No funding was reported, and the investigators did not disclose any relevant financial relationships.

This is a summary of a preprint research study, "Does Capecitabine Maintenance Therapy Versus Active Monitoring Confer a Survival Benefit After First-line Treatment of Metastatic Colorectal Cancer? A Meta-analysis of Randomized Controlled Trials," led by Ling Fan of the Shaanxi Provincial People's Hospital, China, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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