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Capecitabine plus oxaliplatin (XELOX) compared with 5-fluorouracil/leucovorin plus oxaliplatin (FOLFOXs) in advanced gastric cancer: meta-analysis of randomized controlled trials

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Abstract

Purpose

The study aims to compare the efficacy and safety of capecitabine plus oxaliplatin (XELOX) with 5-fluorouracil/leucovorin plus oxaliplatin (FOLFOXs) in patients with advanced gastric cancer.

Methods

Five databases were searched up to June 2014, without language restrictions. The outcomes included overall response rate (ORR), clinical benefit rate (CBR), and toxicity.

Results

Twenty-six eligible trials were selected from 178 studies that initially were identified. All trials were published in Chinese journals between 2005 and 2014 and included 1585 patients (787 in XELOX group and 798 in FOLFOXs group). The pooled results failed to show statistical significance of XELOX regimen on ORR (OR 1.18, 95 % CIs 1.00–1.41, P = 0.057) and CBR (OR 1.10, 95 % CIs 0.95–1.28, P = 0.191) as compared with FOLFOXs regimen. None of the 26 clinical trials reported progression-free survival, and only one reported overall survival rate. The meta-analysis demonstrated that XELOX regimen was associated with a significant lower risk with nausea, stomatitis, diarrhea and alopecia, and a significant higher risk of hand-foot syndrome.

Conclusions

The evidence is limited to suggest that XELOX may share similar efficacy as FOLFOXs and reduce toxicities of chemotherapy in advanced gastric cancer therapy. However, owing to limited data and potential bias of the included studies, further rigorously controlled trials are required.

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Conflict of interest

None

Authors’ contributions

XHB, SR, HF, SFM, and LQZ were responsible for the design of this meta-analysis. XHB and HF performed independently trial selection. XHB and SR were responsible for data acquisition and interpretation of data. XHB, SR, and HF did the statistical analyses. XHB, SFM, and LQZ have been involved in drafting the manuscript.

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    Authors and Affiliations

    1. Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

      Hong-Bin Xu & Qian-Zhou Lv

    2. Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, China

      Hong-Bin Xu, Fang Huang, Rui Su & Fu-Ming Shen

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    1. Hong-Bin Xu
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    2. Fang Huang
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    3. Rui Su
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    Correspondence to Qian-Zhou Lv.

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    Hong-Bin Xu and Fang Huang contributed equally to this work.

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    Xu, HB., Huang, F., Su, R. et al. Capecitabine plus oxaliplatin (XELOX) compared with 5-fluorouracil/leucovorin plus oxaliplatin (FOLFOXs) in advanced gastric cancer: meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 71, 589–601 (2015). https://doi.org/10.1007/s00228-015-1828-9

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    • DOI: https://doi.org/10.1007/s00228-015-1828-9

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