Zhao Lei, Wang Jing, Li Huihui, Che Juanjuan, Cao Bangwei
Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Oncotarget. 2016 May 31;7(22):33418-28. doi: 10.18632/oncotarget.8644.
There is as yet no consensus as to the best choice among the three treatment options (maintenance, complete chemotherapy-free intervals [CFIs], and continuous) for metastatic colorectal cancer (CRC). We performed a meta-analysis of six trials (N = 2, 454 patients) to compare the safety and efficacy of those three treatment strategies. Maintenance appeared to offer an advantage over CFI with respect to progression-free survival (PFS) (hazard ratio [HR]: 0.53, 95% confidence interval [CI], 0.40-0.69). PFS and overall survival (OS) were comparable between the maintenance and continuous strategies (HR: 1.18, 95% CI, 0.96-1.46; HR: 1.05, 95% CI, 0.98-1.27, respectively), as was OS between the maintenance and CFI strategies (HR: 0.84; 95% CI, 0.70-1.00). The incidence of grade 3/4 toxicity, including neutropenia, neuropathy, hand-foot syndrome and fatigue, was lower with maintenance than with continuous therapy. A maintenance regimen utilizing bevacizumab-based doublets appeared to confer a slight advantage over bevacizumab monotherapy with respect to PFS (P = 0.011). Maintenance appeared to reduce cumulative grade 3/4 toxicity as compared to the continuous strategy, while showing comparable efficacy. Bevacizumab-based doublets appeared to be of particular value in patients with metastatic CRC.
对于转移性结直肠癌（CRC）的三种治疗方案（维持治疗、完全无化疗间期[CFI]和持续治疗）中哪种是最佳选择，目前尚无共识。我们对六项试验（N = 2454例患者）进行了荟萃分析，以比较这三种治疗策略的安全性和疗效。在无进展生存期（PFS）方面，维持治疗似乎比CFI具有优势（风险比[HR]：0.53，95%置信区间[CI]，0.40 - 0.69）。维持治疗和持续治疗策略之间的PFS和总生存期（OS）相当（HR分别为：1.18，95% CI，0.96 - 1.46；HR：1.05，95% CI，0.98 - 1.27），维持治疗和CFI策略之间的OS也相当（HR：0.84；95% CI，0.70 - 1.00）。包括中性粒细胞减少、神经病变、手足综合征和疲劳在内的3/4级毒性的发生率，维持治疗低于持续治疗。在PFS方面，使用以贝伐单抗为基础的双联方案的维持治疗似乎比贝伐单抗单药治疗具有轻微优势（P = 0.011）。与持续治疗策略相比，维持治疗似乎降低了累积3/4级毒性，同时显示出相当的疗效。以贝伐单抗为基础的双联方案在转移性CRC患者中似乎具有特殊价值。
