Raltitrexed-based chemotherapy for advanced colorectal cancer

Aims: To evaluate the efficiency and safety profile of raltitrexed-based chemotherapy in the treatment of advanced colorectal cancer. Methods: An electronic search was undertaken to identify randomized controlled trials comparing raltitrexed-based regimen to 5-fluorouracil-based regimen in patients with advanced colorectal cancer. The outcomes included overall survival, overall response rate and toxicities. Results: This meta-analysis included 11 studies with 4622 patients. Overall, there were no significant differences between the two regimens in terms of overall survival (HR = 1.06, 95% CI: 0.96-1.17, P = 0.23) or overall response rate (RR = 1.09, 95% CI: 0.86-1.38, P = 0.47). In subgroup analysis, patients in raltitrexed/oxaliplatin group had significantly higher partial response (RR = 1.53, 95% CI: 1.17-2.00, P = 0.002), overall response rate (RR = 1.42, 95% CI: 1.10-1.82, P = 0.006), disease control rate (RR = 1.16, 95% CI: 1.04-1.29, P = 0.009) and lower progressive disease (RR = 0.61, 95% CI: 0.45-0.84, P = 0.002) when compared to 5-fluorouracil/leucovorin/oxaliplatin group. Occurrence of severe anemia (RR = 2.23, 95% CI: 1.38-3.59, P = 0.0001), asthenia (RR = 2.29, 95% CI: 1.36-3.84, P = 0.002), hepatic disorders (RR = 7.51, 95% CI: 1.30-43.56, P = 0.02), and nausea/vomit (RR = 1.70, 95% CI: 1.03-2.81, P = 0.04) were significantly higher with the raltitrexed arm treatment, while frequencies of grade 3/4 alopecia (RR = 0.36, 95% CI: 0.26-0.50, P < 0.00001) and stomatitis/mucositis (RR = 0.14, 95% CI: 0.07-0.31, P < 0.00001) were increased in the 5-fluorouracil group. Conclusions: Raltitrexed-based chemotherapy regimen leads to an equivalent overall survival and response rates with acceptable toxicities compared to traditional 5-fluorouracil-based regimen in patients with advanced colorectal cancer. Raltitrexed can be a treatment option for these patients when 5-fluorouracil-based regimens are not tolerated or inappropriate. (C) 2013 Elsevier Masson SAS. All rights reserved.