Authors' objectives:

The service evaluated in this review is the use of capecitabine and tegafur with uracil (UFT/LV) as first-line treatments for patient with metastatic colorectal cancer.

Authors' results and conclusions: There is good evidence to suggest that treatment with capecitabine improves overall response rates and has an improved adverse effect profile in comparison with 5-FU/LV treatment with the Mayo regimen, with the exception of handfoot syndrome. There is no evidence comparing capecitabine with infusional 5-FU schedules such as the de Gramont or modified de Gramont regimens, both commonly used as standard treatment in the UK. Time to disease progression or death after treatment with Uftoral(R)/leucovorin (UFT/LV) in one study appears to be shorter than after treatment with 5-FU/LV with the Mayo regimen. There is no evidence comparing UFT/LV with treatment with the de Gramont or modified de Gramont regimen. Treatment with UFT/LV had an improved adverse effect profile compared with 5-FU/LV treatment with the Mayo regimen. Neither capecitabine nor UFT/LV appeared to improve health-related quality of life. Information on patient preference was available for UFT/LV only from a small crossover trial. Patients appeared strongly to prefer treatment with UFT/LV over 5-FU/LV.

Authors' recommendations: The results show that there are cost savings associated with the use of oral therapies. No survival difference has been proven between the oral drugs and the Mayo regimen. In addition, no evidence of a survival difference between the Mayo regimen and the de Gramont regimens has been identified. However, improved progression-free survival and an improved adverse event profile have been shown for the de Gramont regimen over the Mayo regimen and these need to be taken into consideration. These issues can only be indirectly addressed in the absence of direct randomised comparisons between the oral drugs and optimum infusional 5-FU regimens.

Authors' methods: Systematic review, economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/1318

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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