Optimizing the efficacy of first-line chemotherapy plus bevacizumab in metastatic colorectal cancer: analysis of multiple methods.

OBJECTIVE

To assess the efficacy and safety of first-line standard chemotherapy plus bevacizumab in metastatic colorectal cancer and to explore how to optimize therapeutic efficacy.

DESIGN

First, meta-analysis and pooled analysis of three randomized, controlled trials were used to compare response rate (RR), progression-free survival (PFS), overall survival (OS), and grade 3 or 4 adverse events (G3/4AEs) of chemotherapy plus bevacizumab (n = 1169) with those of chemotherapy alone (n = 1148). Second, using six different regimens plus bevacizumab, the Spearman method was used to analyze the correlation between these regimens and OS. Finally, one-way ANOVA was used to compare OS in these regimens.

RESULTS

Overall, chemotherapy plus bevacizumab increased RR by 3.8%, prolonged PFS by 3.0 months and OS by 3.3 months, and increased G3/4AEs by 7.6%. Significant differences were found in PFS (hazard ratio [HR] = 0.65; p = 0.000), OS (HR = 0.79; p = 0.000), and G3/4AEs (risk ratio = 1.12; p = 0.006). However, no statistical difference was found in RR (odds ratio = 1.32; p = 0.17). The optimal regimens with regard to mean OS were capecitabine and irinotecan (CAPIRI) plus bevacizumab (24.00 months) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab (23.97 months).

CONCLUSION

First-line standard chemotherapy plus bevacizumab conferred a significant improvement in OS. In combination with bevacizumab, both CAPIRI and FOLFOX are favorable regimens, though further studies are needed to confirm these results.