A Comparative Effectiveness Study of Two Oral Chemotherapy Drugs (UFT vs. Capecitabine) in Neoadjuvant Concurrent Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer

Abstract

Background/aim: Capecitabine is the current standard oral chemotherapy used in neoadjuvant concurrent chemoradiotherapy (NCCRT) for locally advanced rectal cancer (LARC) in North America. We compared the effectiveness of another oral chemotherapy agent, UFT (an oral combination of uracil and tegafur), to that of capecitabine.

Materials and methods: We identified LARC patients diagnosed from 2007 to 2011 using a population-based registry in Taiwan (Health and Welfare Data Science Center, HWDC) and constructed a propensity score matched cohort to balance observable potential confounders. We compared the hazard ratio (HR) of death between the UFT and capecitabine groups. We performed supplementary analysis (SA) to evaluate the robustness of our finding regarding potential unobserved confounders (SA-1) and the robustness of the result in a subgroup when an additional potential confounder was taken into account (SA-2).

Results: Our study population comprised of 200 patients balanced with respect to observed co-variables. UFT lowered the hazard of death significantly more than capecitabine (HR=0.58, 95% confidence interval (CI)=0.35-0.95, p=0.03). Our result was moderately sensitive in SA-1 but not significant in SA-2.

Conclusion: The effectiveness of UFT in NCCRT for LARC is probably non-inferior to that of capecitabine.

Keywords: Rectal cancer; UFT; capecitabine; neoadjuvant concurrent chemoradiotherapy.