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Evidence summaries

Chemotherapy for Advanced or Metastatic Colorectal Cancer

Chemotherapy prolongs both progression free survival and overall survival compared to best supportive care in patients with advanced or metastatic colorectal cancer. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 13 studies with a total of 1 365 subjects with advanced or metastasized colorectal cancer assessing the effect of palliative chemotherapy on progression free and overall survival. In 9 studies 5-fluorouracil alone or in combination with other agents was used. Other trials evaluated the use of floxuridine (2), irinotecan (1) and tauromustine (1). Meta-analyses were performed using both published data and individual patient data (63%). Chemotherapy was associated with significant improvement in survival at 12 months (RR 0.79; 95% CI 0.72 to 0.89) compared to best supportive care for published data. The reduction for risk of death in individual patient meta-analyses was 35% (HR 0.65; 95% CI 0.56 to 0.76). The effectiveness of palliative chemotherapy did not appear to vary across different age bands. Progression-free survival was also significantly longer in the chemotherapy arms; RR 0.64 at 3 months (95% CI 0.54 to 0.76), 0.78 at 6 months (95% CI 0.69 to 0.88) and 0.86 at 12 months (95% CI 0.77 to 0.96). Treatment toxicity and impact upon quality of life and symptom control have been inadequately assessed in the majority of trials.

    References

    • Palliative chemotherapy for advanced or metastatic colorectal cancer. Colorectal Meta-analysis Collaboration. Cochrane Database Syst Rev 2000;(2):CD001545. [PubMed]

Primary/Secondary Keywords