Publication:

Comparison of the efficacy and safety of the XELOX regimen versus the FOLFOX-4 regimen in metastatic colorectal carcinoma

Background Colorectal cancer is a major cause of cancer-related mortality worldwide. Common regimens such as FOLFOX-4 and XELOX are widely used in metastatic colorectal carcinoma (mCRC), differing in toxicity profiles and administration methods.

Methods This quasi-experimental study included 60 patients with histologically confirmed unresectable mCRC treated at BSMMU from April 2021 to March 2022. Patients were equally assigned to two groups: Arm A received XELOX (oxaliplatin+capecitabine) and Arm B received FOLFOX-4 (oxaliplatin+leucovorin+5-FU). Tumor response and toxicity were assessed using WHO and CTCAE v 5.0 criteria.

Results The median age was 52 years, with 70% male participants. Baseline characteristics were comparable (p> 0.05). At 12 weeks, partial response rates were 46.7% in XELOX and 53.3% in FOLFOX-4, with no significant difference (p=0.605). After treatment completion, partial response was 40.0% and 46.7%, respectively, while progressive disease was higher in XELOX (33.3% vs 20.0%; p=0.668). Median progression-free survival was similar (7.8 vs 8.2 months; p=0.65). Grade 3–4 neutropenia was significantly higher in FOLFOX-4 (40.0% vs 0%, p=0.003), with febrile neutropenia observed only in this group. XELOX showed higher rates of diarrhea (40.0%) and hand-foot syndrome (23.3%).

Conclusions Both regimens demonstrated comparable efficacy. XELOX had more gastrointestinal toxicity, whereas FOLFOX-4 showed higher hematological toxicity. XELOX may be a suitable alternative where outpatient convenience is preferred.