Abstract
In this systematic review, the efficacy and safety of chronomodulated chemotherapy, defined as the delivery of chemotherapy timed according to the human circadian rhythm, were assessed and compared to continuous infusion chemotherapy for patients with advanced colorectal cancer. Electronic English-language studies published until October 2020 were searched. Randomised controlled trials (RCTs) comparing chronomodulated chemotherapy with non-chronomodulated (conventional) chemotherapy for the management of advanced colorectal cancer were included. The main outcomes were the objective response rate (ORR) and system-specific and overall toxicity related to chemotherapy. Electronic databases including Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Review were searched. In total, seven RCTs including 1,137 patients were analysed. Males represented 684 (60%) of the study population. The median age was 60.5 (range = 47.2-64) years. There was no significant difference between chronomodulated and conventional chemotherapy in ORR (risk ratio (RR) = 1.15; 95% confidence interval (CI) = 0.87-1.53). Similarly, there was no significant difference in gastrointestinal toxicity under the random effect model (RR = 1.02; 95% CI = 0.68-1.51). No significant difference was found regarding neurological and skin toxicities (RR = 0.64, 95% CI = 0.32-1.270 and RR = 2.11, 95% CI = 0.33-13.32, respectively). However, patients who received chronomodulated chemotherapy had less haematological toxicity (RR = 0.36, 95% CI = 0.27-0.48). In conclusion, there was no overall difference in ORR or haematologic toxicity between chronomodulated and non-chronomodulated chemotherapy used for patients with advanced colorectal cancer. Chronomodulated chemotherapy can be considered in patients at high risk of haematological toxicities.
| Original language | English |
|---|---|
| Article number | e36522 |
| Number of pages | 20 |
| Journal | Cureus |
| Volume | 15 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 22 Mar 2023 |
Bibliographical note
We would like to thank Kirsty Morrison, Senior Information Specialist, Royal College of Surgeons of England Library and Archives Team, for conducting the literature searches. The datasets generated during and/or analysed during the current study are available in the [SoF copy2.xlsx] and [chronomodulation.rm5] at: https://1drv.ms/u/s!AlzdopwEri123kc7F0pt4YnN8drW?e=lylmBq. AN contributed to abstract screening, full-text review, data extraction, analysis, designing, and writing of the manuscript. AA contributed to abstract screening, full-text review, and data extraction. GR contributed to a substantive and major revision of the draft. MB contributed to conceptualisation, resolution of conflicts during abstract screening and full-text review, and major revision of the draft and is the corresponding author. All authors approved the final version prior to submission.
Access to Document
- Nassar_etal_C_Chronomodulated_administration_of_chemotherapy_VOR
© Copyright 2023Nassar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0.,which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.