S-1 plus oxaliplatin versus capecitabine plus oxaliplatin for first-line treatment of patients with metastatic colorectal cancer: a randomised, non-inferiority phase 3 trial

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• 作者：Prof Yong Sang Hong ; MD^a ; Prof Young Suk Park ; MD^b ; ^{pys27hmo@skku.edu} ; Prof Ho Yeong Lim ; MD^b ; Prof Jeeyun Lee ; MD^b ; Prof Tae Won Kim ; MD^a ; Prof Kyu-pyo Kim ; MD^a ; Sun Young Kim ; MD^c ; Ji Yeon Baek ; MD^c ; Prof Jee Hyun Kim ; MD^d ; Keun-Wook Lee ; MD^d ; Prof Ik-Joo Chung ; MD^e ; Prof Sang-Hee Cho ; MD^e ; Prof Kyung Hee Lee ; MD^f ; Prof Sang Joon Shin ; MD^g ; Hye Jin Kang ; MD^h ; Prof Dong Bok Shin ; MDⁱ ; Sook Jung Jo ; PhD^j ; Prof Jae Won Lee ; PhD^j
• 刊名：Lancet Oncology
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：13
• 期：11
• 页码：1125-1132
• 全文大小：200 K

文摘

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Summary

Background

Capecitabine plus oxaliplatin (CapeOX) is one of the reference doublet cytotoxic chemotherapy treatments for patients with metastatic colorectal cancer. We aimed to compare the efficacy and safety of CapeOX with that of S-1 plus oxaliplatin (SOX), a promising alternative treatment for patients with metastatic colorectal cancer.

Methods

In this open-label, multicentre, randomised phase 3 trial, we randomly assigned patients (1:1) from 11 institutions in South Korea to receive either CapeOX (capecitabine 1000 mg/m² twice daily on days 1-14 and oxaliplatin 130 mg/m² on day 1) or SOX (S-1 40 mg/m² twice daily on days 1-14 and oxaliplatin 130 mg/m² on day 1). Treatment was repeated every 3 weeks and continued for as many as nine cycles of oxaliplatin-containing chemotherapy, except in instances of disease progression, unacceptable toxicity, or a patient's refusal. Maintenance chemotherapy with S-1 or capecitabine was allowed after discontinuation of oxaliplatin. Randomisation was done with a computer-generated sequence (stratified by primary sites, previous adjuvant or neoadjuvant treatment, and the presence of measurable lesions). The primary endpoint was to show non-inferiority of SOX relative to CapeOX in terms of progression-free survival (PFS). The primary analysis was by intention to treat. This study is registered with , number .

Findings

Between May 14, 2008, and Sept 23, 2009, we randomly assigned 168 patients to receive SOX and 172 to receive CapeOX. Median PFS was 8¡¤5 months (95 % CI 7¡¤6-9¡¤3) in the SOX group and 6¡¤7 months (6¡¤2-7¡¤1) in the CapeOX group (hazard ratio, 0¡¤79 [95 % CI 0¡¤60-1¡¤04]; p_{non-inferiority}<0¡¤0001, p_log-rank=0¡¤09). The upper limit of the CI was below the predefined margin of 1¡¤43, showing the non-inferiority of SOX to CapeOX. We recorded a higher incidence of grade 3-4 neutropenia (49 [29 % ] vs 24 [15 % ]), thrombocytopenia (37 [22 % ] vs 11 [7 % ]), and diarrhoea (16 [10 % ] vs seven [4 % ]) in the SOX group than in the CapeOX group. The frequency of any grade of hand-foot syndrome was greater in the CapeOX group than it was in the SOX group (51 [31 % ] vs 23 [14 % ]).

Interpretation

The SOX regimen could be an alternative first-line doublet chemotherapy strategy for patients with metastatic colorectal cancer. Further investigation is needed to explore its potential when used together with other targeted agents or as adjuvant chemotherapy.

Funding

Korea Healthcare Technology Research and Development Project, Ministry of Health and Welfare, South Korea.