Reduced oxaliplatin exposure in gastrointestinal cancers: A systematic review and meta-analysis.
Wallace Klein Schwengber, Fares Jamal, Luis Felipe Leite da Silva et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared reduced oxaliplatin exposure (ROE) with standard-duration oxaliplatin-based therapy in gastrointestinal cancers. It included 24 studies—15 randomised trials and 9 retrospective cohorts—with 30,395 patients. ROE was not associated with statistically significant differences in reported survival outcomes across the cancer settings analysed. It was associated with lower odds of grade 2 peripheral neuropathy (OR 0.46, 95% CI 0.25-0.84), grade ≥ 3 neuropathy (OR 0.34, 95% CI 0.21-0.57), and grade ≥ 3 adverse events (OR 0.67, 95% CI 0.48-0.92).
Key findings
- In adjuvant colorectal cancer, DFS did not differ significantly with ROE (HR 1.06, 95% CI 0.97-1.17; P = 0.15).
- In metastatic colorectal cancer, PFS and OS were not statistically different between exposure strategies.
- ROE was associated with lower odds of grade ≥ 3 CIPN (OR 0.34, 95% CI 0.21-0.57).
- ROE was associated with lower odds of grade ≥ 3 adverse events (OR 0.67, 95% CI 0.48-0.92).
Why it matters
Oxaliplatin-related neuropathy can be severe and persistent, and toxicity may constrain treatment. Across the included evidence, reduced exposure was associated with less neuropathy and fewer high-grade adverse events, without statistically significant survival differences in the analysed settings. These findings help frame the balance between treatment duration and toxicity, while the evidence base is weighted toward colorectal cancer.
What to keep in mind
Evidence was driven predominantly by colorectal cancer; data in pancreatic and gastroesophageal cancers were limited. The review combined randomised trials and retrospective cohorts.