Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis
Open accessAbstract
OBJECTIVES: To determine the benefits and harms of palliative chemotherapy in patients with locally advanced or metastatic colorectal cancer and to compare the outcomes for elderly and younger patients. DESIGN: Meta-analysis of individual patient data and published summary statistics from trials for which individual patient data could not be obtained from the investigators. STUDIES: All randomised controlled trials comparing palliative chemotherapy with supportive care in patients with advanced colorectal cancer that were identified by computerised and hand searches of the literature, scanning references, and contacting investigators. MAIN OUTCOME MEASURES: Survival, disease progression, quality of life, and toxicity. RESULTS: 13 randomised controlled trials including a total of 1365 patients met the inclusion criteria. Meta-analysis of seven trials that provided individual patient data (866 patients) showed that palliative chemotherapy was associated with a 35% reduction in the risk of death (95% confidence interval 24% to 44%). This translates into an absolute improvement in survival of 16% at both six and 12 months and an improvement in median survival of 3.7 months. No age related differences were found in the effectiveness of chemotherapy, but elderly patients were under represented in trials. The overall quality of evidence relating to treatment toxicity, symptom control, and quality of life was poor. CONCLUSIONS: Chemotherapy is effective in prolonging time to disease progression and survival in patients with advanced colorectal cancer. The survival benefit may be underestimated in this analysis as some patients in the control arms received chemotherapy.
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Randomized controlled trials involving PS 0 to PS 2 patients have shown that chemotherapy groups have a significantly longer survival time than BSC groups that did not receive anticancer drugs.
“Randomized controlled trials involving PS 0 to PS 2 patients have shown that chemotherapy groups have a significantly longer survival time than BSC groups that did not receive anticancer drugs [54–56].”
From Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer (2018) · cites this paper as [55]
The Survival section reports significantly longer survival for the chemotherapy group in a pooled analysis of randomized trials. However, the paper does not establish that the patients were restricted to PS 0–2, and the Description of studies and Discussion note that some supportive-care patients subsequently received chemotherapy. The claim’s absolute description of the control groups is therefore not supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredChemotherapy has improved overall survival from approximately 6 months in untreated historical cohorts to 16-20 months for FOLFOX and FOLFIRI combination therapy within clinical trials.
“So far, chemotherapy has improved overall survival from approximately 6 months in untreated historical cohorts18 to 16–20 months for the doublet chemotherapy regimen with intravenous fluorouracil/leucovorin and oxaliplatin (FOLFOX)19 and doublet chemotherapy regimen with intravenous fluorouracil/leucovorin and irinotecan (FOLFIRI)20 combination therapy within clinical trials.”
From Current and emerging concepts for systemic treatment of metastatic colorectal cancer (2025) · cites this paper as [18]
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Current and emerging concepts for systemic treatment of metastatic colorectal cancer
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- Authors
- Colorectal Cancer Collaborative Group
- Affiliations
- Southampton General Hospital (GB)
- Corresponding author
- Colorectal Cancer Collaborative Group
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-09-02
- Volume
- 321
- Issue
- 7260
- Pages
- 531-535
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC27466
- OpenAlex
- W141482010
- Cited by
- 662
- References
- 22
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 3 · 2023: 9 · 2022: 5 · 2021: 11 · 2020: 16 · 2019: 17 · 2018: 8 · 2017: 19 · 2016: 17 · 2015: 26 · 2014: 26 · 2013: 16 · 2012: 22
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
- Keywords
- palliative chemotherapy, advanced colorectal cancer, metastatic colorectal cancer, survival, disease progression, quality of life, chemotherapy toxicity, elderly patients, supportive care
- MeSH terms
- Aged, Antimetabolites, Antineoplastic, Fluorouracil, Humans, Middle Aged, Palliative Care, Colorectal Neoplasms, Proportional Hazards Models, Odds Ratio, Survival Analysis, Randomized Controlled Trials as Topic, Databases, Bibliographic, Treatment Outcome, Disease Progression
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