University Research: Chemotherapy Treatments for Colorectal Cancer

This report investigates the efficacy of chemotherapy drugs in treating colorectal cancer. The research utilizes the PICO question: "Are chemotherapy drugs effective in treating colorectal cancer?" The study employs MEDLINE and CINAHL databases, focusing on articles published after 2013, and uses CASP tools to assess the trustworthiness of the research. Key findings include the effectiveness of FOLFIRI combined with cetuximab or bevacizumab, and the benefits of FOLFIRI with aflibercept in certain patient groups. The report also explores patient perspectives using PROMs and clinician insights, acknowledging limitations like small sample sizes and potential drug interactions. The evidence suggests that oral chemotherapy can be a major part of the colorectal cancer patient’s prescription drug plan, providing them a greater sense of control. Several studies, including those by Heinemann et al. (2014), Van Cutsem et al. (2015), Tabernero et al. (2014), Cremolini et al. (2015), and Stintzing et al. (2016), support these findings.

Bowel cancer
Name of the Student
Name of the University

PICO question
The PICO question for the research is given
below:
• Are chemotherapy drugs effective in
treating colorectal cancer?
• The key phrases and search terms used
for article extraction were “bowel
cancer”, “colorectal cancer”, “treatment”,
“fluorouracil”, “drug”, and
“management”. These key terms were
joined with the use of three boolean
operators namely, OR, AND, and NOT
(McGowan et al. 2016).
P Patients with
colorectal cancer
I Chemotherapy
drugs
C Usual care
O Reduced
symptoms

Selection criteria
• MEDLINE and CINAHL electronic databases were used for extracting articles relevant to the question
being investigated.
Inclusion criteria:
• Articles published in English
• Articles published on or after 2013
• Articles that focused on human subjects
• Research on adult patients
Exclusion criteria:
• Articles published in foreign languages
• Articles published prior to 2013
• Research on animal models
• Articles on children and teenagers

Level of evidences
• All research papers were accessed easily and extracted
following analysis of the titles and abstracts. Most articles
are of high quality evidences and have been appraised
with the use of the CASP toolResearch Number Research Type Source of database
1 Randomised Controlled
Trial
MEDLINE
2 Phase III CRYSTAL study MEDLINE
3 Randomised Controlled
Trial
MEDLINE
4 Randomised Controlled CINAHL

CASP tool
• The primary aim of using CASP was to develop a sense of the
research evidences, and applying them in practice.
• The CASP tool was utilised for adopting a structured approach that
would help in assessing the trustworthiness, value and rigour of the
articles (Singh 2013). The checklist was used for determining
whether the evidences presented in the articles can be used in
future practice.
• CASP tool for randomized controlled trial:
https://casp-uk.net/wp-content/uploads/2018/01/CASP-Randomised-C
ontrolled-Trial-Checklist-2018.pdf

Article 1- Heinemann et al. (2014)
• Randomised controlled trial
• Database- MEDLINE
• Study design- Quantitative
• Research paradigm- Positivism
• No bias reported
• The study concluded that although proportion of colorectal cancer patients
achieving objective responses did not meaningfully vary between
FOLFIRI+cetuximab and FOLFIRI+bevacizumab groups, the connotation with
lengthier complete survival proposed that FOLFIRI+cetuximab was the favoured
first-line regimen for all colorectal cancer patients, having KRAS exon 2 wild type
metastatic colorectal type of cancer.

Article 1- Heinemann et al.
(2014)
• Validity of research using CASP
• What were the findings? 184 patients present in the
FOLFIRI+cetuximab group were able to achieve objective response,
in comparison to 171 patients in the FOLFIRI+ bevacizumab group
• Are the results helpful? Yes
• Were the limitations addressed? No. This was the first randomised
controlled phase 3 trial that compared the efficacy of
FOLFIRI+cetuximab and FOLFIRI+bevacizumab in colorectal
cancer treatment

Article 2- Van Cutsem et al.
(2015)
• Post hoc investigation phase III CRYSTAL study
• Database: MEDLINE
• Study design- Quantitative
• Paradigm type- Not clear
• Probability of selection bias
• The researchers concluded that patients having RAS wild type tumours
were able to obtain significant benefits from administration of
cetuximab+FOLFIRI, while those having RAS tumor mutations failed to
report any benefits.

Article 2- Van Cutsem et al.
(2015)
• Validity of research using CASP
• What were the findings? Significant association found of
administration of cetuximab and FOLFIRI with KRAS exon 2
mutations among colorectal cancer patients
• Are the results helpful? Yes
• Were the limitations addressed? The analysis was restricted to
those patients of CRYSTAL study for whom an detectable DNA
tumour sample was available. There was lack of observed
advantages for patients with other mutations

Article 3- Tabernero et al. (2014)
• Randomised controlled trial
• Database- MEDLINE
• Study design- Quantitative
• Research paradigm- Positivism
• No bias reported
• The researchers concluded that profits of aflibercept, when administered
along with FOLFIRI among patients with metastatic colorectal cancer,
formerly treated with oxaliplatin were upheld across the subgroups, including
patients who were either subjected to prior bevacizumab treatment, or not.

Article 3- Tabernero et al. (2014)
• Validity of research using CASP
• What were the findings? Greater median overall survival were obtained
for FOLFIRI+aflibercept when compared to placebo (12.5 vs. 11.7) among
patients subjected to prior bevacizumab treatment; and 13.9 vs. 12.4 in
patients not subjected to the treatment.
• Are the results helpful? Yes.
• Were the limitations addressed? No. The authors suggested that
significant improvement was found in PFS and OS when aflibercept was
added to FOLFIRI for treatment of mCRC patients who were previously
treated with oxaliplatin.

Article 4- Cremolini et al. (2015)
• Multicentre, phase III randomised controlled trial
• Database- CINAHL
• Research Design- Quantitative
• Research paradigm type- Positivism
• No bias reported.
• The researchers identified FOLFOXIRI+bevacizumab as a practicable
treatment option for patients having bowel cancer, regardless of their
BRAF or RAS mutational status and baseline clinical characteristics.