One phase III RCT and two phase II RCTs were included in the review (n=1,294 patients in text, 1284 in table 1; range 62 to 1,002). One RCT scored 3 on the Jadad scale and two RCTs scored 2.
Effectiveness: When the three RCTs were combined, oxaliplatin was associated with a significantly lower risk of death (HR 0.88, 95% CI 0.78 to 0.99) and cancer progression (HR 0.88, 95% CI 0.80 to 0.98). The absolute benefit represented a risk reduction of 12% for death and progression. There was no significant difference between the treatment groups for response rates.
Safety: When the three RCTs were pooled, oxaliplatin was associated with a significantly lower risk of high-grade neutropenia (OR 0.53, 95% CI 0.41 to 0.69), high-grade anaemia (OR 0.64, 95% CI 0.41 to 0.98), alopecia (OR 0.56, 95% CI 0.41 to 0.74) and thromboembolism (OR 0.42, 95% CI 0.28 to 0.64). However, oxaliplatin was associated a significantly higher risk of high-grade diarrhoea (OR 2.73, 95% CI 1.66 to 4.49) and high-grade neurotoxicity (OR 6.91, 95% CI 3.08 to 15.46). Rates of thrombocytopenia, nausea/vomiting and stomatitis did not differ significantly between the treatment groups. One RCT (n=220) reported that bi-weekly two-drug oxaliplatin was associated with significantly higher compliance and tolerability than cisplatin, especially in older participants (aged over 65 years).
Results for all-grade toxicity and sensitivity analyses were also reported.
There was no significant heterogeneity for most outcome except all-grade diarrhoea (p<0.01).