The Clinical and Economic Benefits of Capecitabine and Tegafur with Uracil in Metastatic Colorectal Cancer

Overview

Journal Br J Cancer

Specialty Oncology

Date 2006 Jun 29

PMID 16804526

Citations 20

Authors

S E Ward

E Kaltenthaler

J Cowan

M Marples

B Orr

M T Seymour

Affiliations

Soon will be listed here.

Abstract

Two oral fluoropyrimidine therapies have been introduced for metastatic colorectal cancer. One is a 5-fluorouracil pro-drug, capecitabine; the other is a combination of tegafur and uracil administered together with leucovorin. The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of these oral therapies against standard intravenous 5-fluorouracil regimens. A systematic literature review was conducted to assess the clinical effectiveness of the therapies and costs were calculated from the UK National Health Service perspective for drug acquisition, drug administration, and the treatment of adverse events. A cost-minimisation analysis was used; this assumes that the treatments are of equal efficacy, although direct randomised controlled trial (RCT) comparisons of the oral therapies with infusional 5-fluorouracil schedules were not available. The cost-minimisation analysis showed that treatment costs for a 12-week course of capecitabine (Pounds 2132) and tegafur with uracil (Pounds 3385) were lower than costs for the intravenous Mayo regimen (Pounds 3593) and infusional regimens on the de Gramont (Pounds 6255) and Modified de Gramont (Pounds 3485) schedules over the same treatment period. Oral therapies result in lower costs to the health service than intravenous therapies. Further research is needed to determine the relative clinical effectiveness of oral therapies vs infusional regimens.

Citing Articles

The Persistence of Hydrogen Bonds in Pyrimidinones: From Solution to Crystal.

Farias F, Mittersteiner M, Kieling A, Lima P, Weimer G, Bonacorso H ACS Org Inorg Au. 2024; 4(5):557-570.

PMID: 39371326 PMC: 11450830. DOI: 10.1021/acsorginorgau.4c00057.

New MoS/Tegafur-Containing Pharmaceutical Formulations for Selective LED-Based Skin Cancer Photo-Chemotherapy.

Campos M, Silva F, Fernandes J, Santos S, Magalhaes F, Oliveira M Pharmaceutics. 2024; 16(3).

PMID: 38543254 PMC: 10974967. DOI: 10.3390/pharmaceutics16030360.

Phase III trial comparing UFT + PSK to UFT + LV in stage IIB, III colorectal cancer (MCSGO-CCTG).

Miyake Y, Nishimura J, Kato T, Ikeda M, Tsujie M, Hata T Surg Today. 2017; 48(1):66-72.

PMID: 28634730 DOI: 10.1007/s00595-017-1555-1.

Adherence and Patients' Experiences with the Use of Capecitabine in Daily Practice.

Timmers L, Boons C, Mangnus D, van de Ven P, van den Berg P, Beeker A Front Pharmacol. 2016; 7:310.

PMID: 27708578 PMC: 5030243. DOI: 10.3389/fphar.2016.00310.

Real-world cost analysis of chemotherapy for colorectal cancer in Japan: detailed costs of various regimens during the entire course of chemotherapy.

Yajima S, Shimizu H, Sakamaki H, Ikeda S, Ikegami N, Murayama J BMC Health Serv Res. 2016; 16:2.

PMID: 26728154 PMC: 4698819. DOI: 10.1186/s12913-015-1253-x.

References

Borner M, Schoffski P, de Wit R, Caponigro F, Comella G, Sulkes A . Patient preference and pharmacokinetics of oral modulated UFT versus intravenous fluorouracil and leucovorin: a randomised crossover trial in advanced colorectal cancer. Eur J Cancer. 2002; 38(3):349-58. DOI: 10.1016/s0959-8049(01)00371-9. View

Ward S, Kaltenthaler E, Cowan J, Brewer N . Clinical and cost-effectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: systematic review and economic evaluation. Health Technol Assess. 2003; 7(32):1-93. DOI: 10.3310/hta7320. View

Maughan T, James R, Kerr D, Ledermann J, Seymour M, Topham C . Comparison of intermittent and continuous palliative chemotherapy for advanced colorectal cancer: a multicentre randomised trial. Lancet. 2003; 361(9356):457-64. DOI: 10.1016/s0140-6736(03)12461-0. View

Lloyd Jones M, Hummel S, Bansback N, Orr B, Seymour M . A rapid and systematic review of the evidence for the clinical effectiveness and cost-effectiveness of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer. Health Technol Assess. 2002; 5(25):1-128. View

Ollendorf D . Impact of uracil/tegafur plus oral calcium folinate on resource utilization. Oncology (Williston Park). 1999; 13(7 Suppl 3):42-3. View

Piedbois P, Rougier P, Buyse M, Pignon J, Ryan L, Hansen R . Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. J Clin Oncol. 1998; 16(1):301-8. DOI: 10.1200/JCO.1998.16.1.301. View

Murad A, Andrade C, Delfino C, Arikian S, Doyle J, Dezii C . [Not Available]. Clin Drug Investig. 1997; 13(2):90-8. DOI: 10.2165/00044011-199713020-00005. View

Seymour M, Stenning S, Cassidy J . Attitudes and practice in the management of metastatic colorectal cancer in Britain. Colorectal Cancer Working Party of the UK Medical Research Council. Clin Oncol (R Coll Radiol). 1997; 9(4):248-51. DOI: 10.1016/s0936-6555(97)80010-6. View

Twelves C, Boyer M, Findlay M, Cassidy J, Weitzel C, Barker C . Capecitabine (Xeloda) improves medical resource use compared with 5-fluorouracil plus leucovorin in a phase III trial conducted in patients with advanced colorectal carcinoma. Eur J Cancer. 2001; 37(5):597-604. DOI: 10.1016/s0959-8049(00)00444-5. View

10.

Rougier P, Mitry E . Epidemiology, treatment and chemoprevention in colorectal cancer. Ann Oncol. 2003; 14 Suppl 2:ii3-5. DOI: 10.1093/annonc/mdg722. View

11.

Young A, Rea D . ABC of colorectal cancer: treatment of advanced disease. BMJ. 2000; 321(7271):1278-81. PMC: 1119016. DOI: 10.1136/bmj.321.7271.1278. View

12.

Iveson T, Hickish T, Schmitt C, Van Cutsem E . Irinotecan in second-line treatment of metastatic colorectal cancer: improved survival and cost-effect compared with infusional 5-FU. Eur J Cancer. 2000; 35(13):1796-804. DOI: 10.1016/s0959-8049(99)00186-0. View

13.

Twelves C . Capecitabine as first-line treatment in colorectal cancer. Pooled data from two large, phase III trials. Eur J Cancer. 2002; 38 Suppl 2:15-20. DOI: 10.1016/s0959-8049(01)00415-4. View

14.

Van Cutsem E, Twelves C, Cassidy J, Allman D, Bajetta E, Boyer M . Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol. 2001; 19(21):4097-106. DOI: 10.1200/JCO.2001.19.21.4097. View

15.

Cunningham D, Falk S, Jackson D . Clinical and economic benefits of irinotecan in combination with 5-fluorouracil and folinic acid as first line treatment of metastatic colorectal cancer. Br J Cancer. 2002; 86(11):1677-83. PMC: 2375396. DOI: 10.1038/sj.bjc.6600204. View

16.

Cheeseman S, Joel S, Chester J, Wilson G, Dent J, Richards F . A 'modified de Gramont' regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer. Br J Cancer. 2002; 87(4):393-9. PMC: 2376131. DOI: 10.1038/sj.bjc.6600467. View

17.

Poon M, Oconnell M, MOERTEL C, Wieand H, Cullinan S, Everson L . Biochemical modulation of fluorouracil: evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. J Clin Oncol. 1989; 7(10):1407-18. DOI: 10.1200/JCO.1989.7.10.1407. View

18.

Hoff P, Ansari R, Batist G, Cox J, Kocha W, Kuperminc M . Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. J Clin Oncol. 2001; 19(8):2282-92. DOI: 10.1200/JCO.2001.19.8.2282. View

19.

Douillard J, Hoff P, Skillings J, Eisenberg P, Davidson N, Harper P . Multicenter phase III study of uracil/tegafur and oral leucovorin versus fluorouracil and leucovorin in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2002; 20(17):3605-16. DOI: 10.1200/JCO.2002.04.123. View

20.

Murad A, de Andrade C, Delfino C, Arikian S, Doyle J, Sinha N . A pharmacoeconomic comparison of UFT and 5-FU chemotherapy for colorectal cancer in South America. Oncology (Williston Park). 1998; 11(9 Suppl 10):128-35. View