Comparison of efficacy and safety of S-1 and capecitabine in patients with metastatic colorectal carcinoma A systematic review and meta-analysis

Background: This study aimed to compare the efficacy and safety of S-1 and capecitabine in patients with metastatic colorectal carcinoma (mCRC). Methods: Eligible prospective clinical trials were searched and available data were extracted. Odds ratio and hazard ratio of available outcomes including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were pooled for analysis. Results: A total of 6 studies including 828 patients were included. The results of pooled analysis showed no statistical difference in short-term efficacy including ORR (95% confidence interval [CI]: 0.68-1.19; P=.48) or DCR (95% CI: 0.65-1.29; P=.61), or long-term efficacy including PFS (95% CI: 0.75-1.08; P=.26) or OS (95% CI: 0.78-1.13; P=.50). Symptoms of diarrhea at any grade were more prevalent (95% CI: 1.21-2.29; P=.002) in patients treated with S-1, while hand-foot syndrome (HFS) at any grade (95% CI: 0.24-0.48; P<.0001) or high grade (95% CI: 0.09-0.48; P<.0001) was more frequent in capecitabine group. AEs including leucopenia, neutropenia, anemia, thrombocytopenia, vomiting, oral mucositis, stomatitis, elevated alanine transaminase, or peripheral neuropathy showed no statistical difference between S-1 and capecitabine group (all P>.05). Conclusions: This meta-analysis reveals that S-1 has comparable efficacy, lower risk of HFS and higher incidence of diarrhea compared to capecitabine for treatment in patients with mCRC.