Should capecitabine replace 5-fluorouracil in the first-line treatment of metastatic colorectal cancer?

Table 6 Comparison of treatment safety (Grade 3/4 events) in combination with irinotecan

Clinical trial	Treatments	Diarrhea	Vomiting	Neutropenia	HFS
Fuchs et al[39] (2007)	1CapeIRI vs FOLFIRI vs mIFL	47.5% vs 13.9% vs 19.0%	18.4% vs 8.8% vs 7.3%	31.9% vs 43.1% vs 40.9%	9.9% vs 0% vs 0%
Köhne et al[34] (2008)2	CAPIRI vs FOLFIRI-2
	+ Celecoxib	39% vs 17%	9% vs 6%	13% vs 11%	< 1% vs 0%
	- Celecoxib	35% vs 10%	5% vs 5%	15% vs 19%	< 1% vs 0%
Souglakos et al[40] (2012)	CAPIRI + Bev vs FOLFIRI-2 + Bev	15.8% vs 9.2%a	-	17.9% vs 24.5%	4.2% vs 1.2%a
Pectasides et al[41] (2012)	XELIRI + Bev vs FOLFIRI + Bev	19% vs 11%	5% vs 0%c	13% vs 22%	-
Ducreux et al[42] (2013)	XELIRI-2+ Bev vs FOLFIRI + Bev	12% vs 5%	7% vs 7%	18% vs 26%	6% vs 1%

¹Arm excluded after protocol amendment for toxicity;

²Premature termination due to toxicity (inconclusive results). Treatments: CapeIRI (CAPIRI): 250 mg/m² Irinotecan (day 1) + 1000 mg/m² capecitabine (days 1-14), 3-wk regimen cycle; FOLFIRI: 180 mg/m² irinotecan + 400 mg/m² LV + 400 mg/m² 5-FU bolus + 2400 mg/m² 5-FU 46-h continuous infusion, 2-wk regimen cycle; mIFL: 125 mg/m² irinotecan + 20 mg/m² LV + 500 mg/m² 5-FU bolus (days 1 and 8), 3-wk regimen cycle; FOLFIRI-2: 180 mg/m² irinotecan (days 1, 15, 22) + 200 mg/m² LV (days 1, 2, 15, 16, 29, and 30)+ 400 mg/m² bolus 5-FU, 600 mg/m² 22-h continuous infusion 5-FU (1, 2, 15, 16, 29 and 30); XELIRI: 240 mg/m² irinotecan + 1000 mg/m² capecitabine (days 1-14), 3-wk treatment regimen; XELIRI-2: 200 mg/m² irinotecan + 1000 mg/m² capecitabine (days 1-14), 3-wk treatment regimen. Bev: Bevacizumab; HFS: Hand-foot syndrome;

^aP < 0.05 vs CAPIRI + Bev;

^cP < 0.05 vs XELIRI + Bev.