A systematic review of the safety profile of the different combinations of fluoropyrimidines and oxaliplatin in the treatment of colorectal cancer patients

• Published in: Critical reviews in oncology/hematology 2018-02, Vol.122, p.21-29
• Main Authors: Baratelli, Chiara, Zichi, Clizia, Di Maio, Massimo, Brizzi, Maria Pia, Sonetto, Cristina, Scagliotti, Giorgio Vittorio, Tampellini, Marco
• Format: Article
• Language: English
• Subjects: 5-fluorouracil; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Capecitabine; Capecitabine - administration & dosage; Capecitabine - adverse effects; Colorectal cancer; Colorectal Neoplasms - drug therapy; Deoxycytidine - administration & dosage; Deoxycytidine - adverse effects; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Humans; Leucovorin - administration & dosage; Leucovorin - adverse effects; Organoplatinum Compounds - administration & dosage; Organoplatinum Compounds - adverse effects; Oxaliplatin; Safety profile; Tolerability
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2017.12.010

•Reduced risk of haematological toxicities with 5-FU single bolus regimens.•37% of patients treated with double bolus 5-FU experiencing grade 3–4 neutropenia.•The lowest risk of gastrointestinal toxicities with 5-FU single bolus regimens.•Non bolus regimens caused peripheral neuropathy in 80% of patients. The available fluoropyrimidines and oxaliplatin combinations for colorectal cancer patients have different safety profiles. The aim of this systematic review was to compare their toxicities. The eligible studies were classified as: no bolus; 5-FU single bolus; 5-FU double bolus; capecitabine. We calculated the incidence of “any-grade” and “severe” toxicity for haematological and non-haematological adverse events of each group. We identified 184 treatment groups; compared to 5-FU double bolus, except for high-grade anaemia, all the groups showed reduced risk of haematological toxicities, with the most relevant advantages for single bolus regimens. Concerning non-haematological toxicities, compared to double bolus, the single bolus group showed a statistically significant reduced risk for many gastrointestinal toxicities and for pheripheral neuropathy. This is the first systematic review of the toxicity profile of different 5-FU or capecitabine and oxaliplatin regimens. Single 5-FU bolus is associated with a definitely favourable toxicity profile, both for haematological and non-haematological toxicity.