BACKGROUND: Before the emergence of first-line combination chemotherapy, the standard of care for unresectable metastatic @entity14 (mcrc) was first-line monotherapy with modulated @entity1487 . Several large phase iii randomized controlled trials, now completed, have assessed whether a planned sequential chemotherapy strategy-beginning with fluoropyrimidine monotherapy until treatment failure, followed by another regimen (either monotherapy or combination chemotherapy) until treatment failure-could result in the same survival benefit produced with an upfront combination chemotherapy strategy, but with less @entity137 for @entity1 . METHODS: The medline and embase databases, and abstracts from meetings of the American Society for Clinical Oncology and the European Society for Medical Oncology, were searched for reports comparing a sequential strategy of chemotherapy with an upfront combination chemotherapy in adult @entity1 with mcrc. Publications that reported efficacy or @entity137 data (or both) were included. RESULTS: The five eligible trials that were identified included 4532 @entity1 . A meta-analysis of those trials demonstrates a statistically significant survival advantage for combination chemotherapy (hazard ratio: 0.92; 95% confidence interval: 0.86 to 0.99). However, the median survival advantage (3-6 weeks in most trials) is small and of questionable clinical significance. Three trials reported first-line @entity137 . Upfront combination chemotherapy results in significantly more @entity1398 , @entity1398 , @entity882 , @entity294 , @entity390 , @entity391 , and @entity16 . Sequential chemotherapy results in significantly more @entity8566 . CONCLUSIONS: Given the small survival advantage associated with upfront combination chemotherapy, planned sequential chemotherapy and upfront combination chemotherapy can both be considered treatment strategies. Treatment should be chosen on an individual basis considering @entity1 and @entity5 characteristics, @entity137 of each strategy, and @entity1 preference.

Strategies of sequential therapies in unresectable metastatic XXXX : a meta-analysis.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity', 'toxicities'] @entity390 :: ('MESH:D009325', 'Disease') :: ['nausea'] @entity882 :: ('MESH:D013921', 'Disease') :: ['thrombocytopenia'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumour'] @entity294 :: ('MESH:D003967', 'Disease') :: ['diarrhea'] @entity391 :: ('MESH:D014839', 'Disease') :: ['vomiting'] @entity16 :: ('MESH:D009422', 'Disease') :: ['sensory neuropathy'] @entity1398 :: ('MESH:D009503', 'Disease') :: ['neutropenia', 'febrile neutropenia'] @entity8566 :: ('MESH:D060831', 'Disease') :: ['hand-foot syndrome'] @entity14 :: ('MESH:D015179', 'Disease') :: ['colorectal cancer'] @entity1487 :: ('MESH:D005472', 'Chemical') :: ['5-fluorouracil']
@entity14 :: (MESH:D015179,Disease) :: ['colorectal cancer']
