Capecitabine Versus Continuous-Infusion 5-Fluorouracil for Colorectal Cancer: A Retrospective Efficacy and Safety Comparison

For more than 40 years, 5-fluorouracil (5-FU) has been considered the most effective systemic agent for managing advanced colorectal cancer. However, continuous-infusion (CI) schedules of 5-FU require central venous access devices, which are associated with catheter complications and are an inconvenience to patients. The novel oral fluoropyrimidine capecitabine appears to offer comparable efficacy while providing a more convenient schedule that is often preferred by patients. Published phase II/III clinical studies of capecitabinebased regimens for colorectal cancer were compared with key studies of CI 5-FU-based regimens to assess safety, efficacy, quality of life, and pharmacoeconomics. Studies were identified via Medline searches and conference abstracts dating back to 1997. Qualitative analyses show that capecitabine as a single agent as well as in combination regimens is an effective first-line treatment for metastatic colorectal cancer, providing a higher response rate compared with standard 5-FU/leucovorin. Costs associated with capecitabine also appear to be lower than those associated with catheter-based therapies. Capecitabine offers physicians a more convenient treatment for advanced colorectal cancer, with manageable toxicity and antitumor activity comparable to that of CI therapies.