Replacing 5-fluorouracil by capecitabine in localised squamous cell carcinoma of the anal canal
Capecitabine is a suitable oral alternative to infusional 5‑fluorouracil in chemoradiation for localised squamous cell carcinoma of the anal canal, delivering comparable complete response rates.
Background: The standard treatment for localised squamous cell carcinoma of the anal canal (SCCAC) is chemoradiotherapy (CRT) with infusional 5‑fluorouracil (5‑FU) and mitomycin. Because 5‑FU and capecitabine have offered similar efficacy in many phase‑III trials of solid tumours, studies have tested capecitabine in this setting of SCCAC. However, these studies are small and have reported variable results. Therefore, a systematic review and meta‐analysis was performed. Methods: Medline, Scopus and Embase were searched for studies that evaluated the efficacy outcomes of capecitabine used as a substitute of 5‑FU in the CRT of localised SCCAC. The primary endpoint was complete response rate (CRR) at 6 months. Results: We retrieved 300 studies, of which six met our eligibility criteria. The capecitabine dose ranged from 500 mg/m² to 825 mg/m² BID for 5 days per week during radiation. With a total of 218 patients, the median follow‑up was 21.5 months. The pooled analysis of three trials (N = 132 patients) reported a CRR at 6 months of 88 % (83–94 %), considering all clinical stages. The pooled analysis of overall CRR (N = 218 patients), evaluated at different intervals, showed an overall CRR of 91 % (87–95 %). Rates of locoregional relapse varied from 3.2 % to 21 %. The majority of patients completed the planned radiotherapy dose (93.5–100 %) and any chemotherapy interruption was reported in up to 55.8 % of patients. Conclusions: Capecitabine is an acceptable and more convenient alternative to infusional 5‑FU in the CRT for localised SCCAC, offering similar clinical CRR to those reported by phase‑III trials.
Providing an oral, convenient substitute for intravenous 5‑FU could improve patient compliance, reduce the need for central venous access and hospital visits, and make effective chemoradiation more accessible, particularly in low‑ and middle‑income settings, while maintaining comparable clinical response rates.
Evidence level: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.
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