Abstract
Introduction: We performed a meta-analysis in order to analyze and quantify the effect on survival of starting therapy in RAS wild-type (wt) metastatic colorectal cancer (mCRC) patients with anti-EGFR agents or bevacizumab. Patients and Methods: Randomized, phase II or III, clinical trials reporting overall survival (OS) in RAS wt mCRC patients treated with first-line chemotherapy (CT) associated with bevacizumab or anti-EGFR agents were selected. The primary end-point of this meta-analysis was OS; findings were depicted in classical Forest plots. Results: Seven studies met the criteria for meta-analysis including 3,805 patients. The pooled second-line cross-over rate to bevacizumab was 36.6%, to anti-EGFR 33.2%. Only one study was selected reporting comparison between CT vs. CT plus bevacizumab in RAS wt patients with a HR of 1.13 in favor of CT (CI: 0.89-1.43, p = 0.317). The pooled HRs were 0.89 (95% CI: 0.79-1.00) for CT plus anti-EGFR vs. CT and 0.81 (95% CI: 0.71-0.92) in favor of CT plus anti-EGFR vs. CT plus bevacizumab. Subgroup analysis showed a positive prognostic impact of starting CT plus anti-EGFR in left colon cancer (pooled HR: 0.70; CI: 0.54-0.85) while a positive trend of starting CT plus bevacizumab was observed in right colon cancer (pooled HR: 1.29; CI: 0.81-1.77). Conclusions: This meta-analysis shows that starting therapy in RAS wt mCRC patients with an anti-EGFR agent improves OS when the primary tumor location is in the left colon but a strong limitation of previous studies is the very low rate of biologic drug therapy cross-over.
| Original language | English |
|---|---|
| Article number | 441 |
| Journal | Frontiers in Pharmacology |
| Volume | 9 |
| Issue number | MAY |
| DOIs | |
| Publication status | Published - May 3 2018 |
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Keywords
- Bevacizumab
- Cetuximab
- Chemotherapy
- Colorectal carcinoma
- Panitumumab
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
Cite this
First biologic drug in the treatment of RAS wild-type metastatic colorectal cancer : Anti-EGFR or Bevacizumab? Results from a meta-analysis. / Ottaiano, Alessandro; De Stefano, Alfonso; Capozzi, Monica; Nappi, Anna; De Divitiis, Chiara; Romano, Carmela; Silvestro, Lucrezia; Cassata, Antonino; Casaretti, Rossana; Tafuto, Salvatore; Caraglia, Michele; Berretta, Massimiliano; Nasti, Guglielmo; Avallone, Antonio.
In: Frontiers in Pharmacology, Vol. 9, No. MAY, 441, 03.05.2018.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - First biologic drug in the treatment of RAS wild-type metastatic colorectal cancer
T2 - Anti-EGFR or Bevacizumab? Results from a meta-analysis
AU - Ottaiano, Alessandro
AU - De Stefano, Alfonso
AU - Capozzi, Monica
AU - Nappi, Anna
AU - De Divitiis, Chiara
AU - Romano, Carmela
AU - Silvestro, Lucrezia
AU - Cassata, Antonino
AU - Casaretti, Rossana
AU - Tafuto, Salvatore
AU - Caraglia, Michele
AU - Berretta, Massimiliano
AU - Nasti, Guglielmo
AU - Avallone, Antonio
PY - 2018/5/3
Y1 - 2018/5/3
N2 - Introduction: We performed a meta-analysis in order to analyze and quantify the effect on survival of starting therapy in RAS wild-type (wt) metastatic colorectal cancer (mCRC) patients with anti-EGFR agents or bevacizumab. Patients and Methods: Randomized, phase II or III, clinical trials reporting overall survival (OS) in RAS wt mCRC patients treated with first-line chemotherapy (CT) associated with bevacizumab or anti-EGFR agents were selected. The primary end-point of this meta-analysis was OS; findings were depicted in classical Forest plots. Results: Seven studies met the criteria for meta-analysis including 3,805 patients. The pooled second-line cross-over rate to bevacizumab was 36.6%, to anti-EGFR 33.2%. Only one study was selected reporting comparison between CT vs. CT plus bevacizumab in RAS wt patients with a HR of 1.13 in favor of CT (CI: 0.89-1.43, p = 0.317). The pooled HRs were 0.89 (95% CI: 0.79-1.00) for CT plus anti-EGFR vs. CT and 0.81 (95% CI: 0.71-0.92) in favor of CT plus anti-EGFR vs. CT plus bevacizumab. Subgroup analysis showed a positive prognostic impact of starting CT plus anti-EGFR in left colon cancer (pooled HR: 0.70; CI: 0.54-0.85) while a positive trend of starting CT plus bevacizumab was observed in right colon cancer (pooled HR: 1.29; CI: 0.81-1.77). Conclusions: This meta-analysis shows that starting therapy in RAS wt mCRC patients with an anti-EGFR agent improves OS when the primary tumor location is in the left colon but a strong limitation of previous studies is the very low rate of biologic drug therapy cross-over.
AB - Introduction: We performed a meta-analysis in order to analyze and quantify the effect on survival of starting therapy in RAS wild-type (wt) metastatic colorectal cancer (mCRC) patients with anti-EGFR agents or bevacizumab. Patients and Methods: Randomized, phase II or III, clinical trials reporting overall survival (OS) in RAS wt mCRC patients treated with first-line chemotherapy (CT) associated with bevacizumab or anti-EGFR agents were selected. The primary end-point of this meta-analysis was OS; findings were depicted in classical Forest plots. Results: Seven studies met the criteria for meta-analysis including 3,805 patients. The pooled second-line cross-over rate to bevacizumab was 36.6%, to anti-EGFR 33.2%. Only one study was selected reporting comparison between CT vs. CT plus bevacizumab in RAS wt patients with a HR of 1.13 in favor of CT (CI: 0.89-1.43, p = 0.317). The pooled HRs were 0.89 (95% CI: 0.79-1.00) for CT plus anti-EGFR vs. CT and 0.81 (95% CI: 0.71-0.92) in favor of CT plus anti-EGFR vs. CT plus bevacizumab. Subgroup analysis showed a positive prognostic impact of starting CT plus anti-EGFR in left colon cancer (pooled HR: 0.70; CI: 0.54-0.85) while a positive trend of starting CT plus bevacizumab was observed in right colon cancer (pooled HR: 1.29; CI: 0.81-1.77). Conclusions: This meta-analysis shows that starting therapy in RAS wt mCRC patients with an anti-EGFR agent improves OS when the primary tumor location is in the left colon but a strong limitation of previous studies is the very low rate of biologic drug therapy cross-over.
KW - Bevacizumab
KW - Cetuximab
KW - Chemotherapy
KW - Colorectal carcinoma
KW - Panitumumab
UR - http://www.scopus.com/inward/record.url?scp=85046625470&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046625470&partnerID=8YFLogxK
U2 - 10.3389/fphar.2018.00441
DO - 10.3389/fphar.2018.00441
M3 - Review article
AN - SCOPUS:85046625470
VL - 9
JO - Frontiers in Pharmacology
JF - Frontiers in Pharmacology
SN - 1663-9812
IS - MAY
M1 - 441
ER -