Maintenance treatment after first-line
chemotherapy for patients with metastatic
colorectal cancer (mCRC) is a priority strategy. However, which medicine is chosen is controversial. This study aimed to determine the efficacy and safety of maintenance treatment with metronomic
capecitabine vs observation.In this randomized controlled trial, patients who completed 18 weeks of
induction chemotherapy with
XELOX and achieved disease control were randomly assigned centrally (1:1) to receive maintenance
therapy with metronomic
chemotherapy or observation until
disease progression. The primary endpoint was progression-free survival from randomization; secondary endpoints included overall survival and safety. Analyses were performed by intention to treat.Between January 1st, 2017 and December 31th 2018, 48 patients were enrolled and randomly assigned to receive maintenance treatment with metronomic
capecitabine (n = 25) or only observation (n = 23). The median progression-free survival in the metronomic
capecitabine group was 5.66 (95% confidence interval [CI] 5.25-6.07) months vs 3.98 (95%CI 3.71-4.24) months in the observation group (hazard ratio 0.11, 95% [CI] 0.04-0.26, P = .000). There was no statistically significant difference in median overall survival: 23.82 (95% CI 22.38-25.25) months in the metronomic
capecitabine group vs 21.81 (95% CI 20.23-23.38) months in the observation group (hazard ratio 0.49, 95% CI 0.21-1.11, P = .087). Subgroup analyses were generally consistent with the primary finding. Similar safety profiles were observed in both arms. The most frequent adverse events in metronomic
capecitabine group included
neutropenia,
diarrhea, hand-foot skin reaction, and
mucositis.Maintenance
therapy with metronomic
capecitabine can be considered an alternative option following first-line
chemotherapy of
XELOX in patients with metastatic
colorectal cancer with controlled toxicities.