Piedbois P, Buyse M. What can we learn from a meta-analysis of trials testing the modulation of 5-FU by leucovorin? Advanced Colorectal Meta-analysis Project.
Ann Oncol 1993;
4 Suppl 2:15-9. [PMID:
8353100 DOI:
10.1093/annonc/4.suppl_2.s15]
[Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND DESIGN
We previously reported a meta-analysis of all randomized clinical trials comparing 5-FU to 5-FU plus intravenous d.l. leucovorin (LV) in patients with advanced colorectal cancer.
RESULTS
The meta-analysis confirmed the advantage of 5-FU/LV over 5-FU alone in terms of response rate: overall, the response rate was 11% with 5-FU alone vs 23% with 5-FU/LV (p < 10(-7)). At the same time, it was showed that tumor regression can not be considered a surrogate end point for survival in patients with advanced colorectal cancer: no significant survival advantage was observed for patients allocated to 5-FU/LV. The present paper focuses on the interest of meta-analysis to study the role of the biomodulation of 5-FU by LV. This approach is compared with the analysis of individual clinical trials in terms of power, bias and credibility. It is argued that for the meta-analysis to be reliable, individual patient data from all available studies must be used, rather than summary data extracted from published papers.
CONCLUSION
It is concluded that meta-analysis is very useful as a tool to explore and summarize available data on a given clinical problem, though its purpose is not to recommend any treatment modality. This meta-analysis has confirmed both the benefit of biomodulation of 5-FU by LV, and the limitations of the current modalities to impact significantly on overall patient survival. Further laboratory and clinical research is warranted on the biomodulation of 5-FU by LV.
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