The role of angiogenesis inhibitors re-challenge in colorectal cancer previously treated with bevacizumab: a meta-analysis of randomized controlled trials.

OBJECTIVE

The potential usefulness of angiogenesis inhibitors (AIs) re-challenge in the treatment of metastatic colorectal cancer (CRC) who previously treated with bevacizumab has not been established yet.

MATERIALS AND METHODS

We identified relevant clinical studies through searching databases up to October 2016. Prospective clinical trials investigating AIs re-challenge in metastatic CRC were included for analysis. The primary endpoint was overall survival with secondary endpoint progression-free survival. Estimates of treatment effect from individual trials were combined using standard techniques.

RESULTS

A total of 2.686 patients with metastatic CRC who previously received bevacizumab were identified for analysis. The meta-analysis results demonstrated that AI re-challenge significantly improved progression-free survival (hazard ratio: 0.63, 95% confidence interval: 0.52-0.76, p < 0.001) and overall survival (hazard ratio: 0.82, 95% confidence interval: 0.76-0.89, p < 0.001) when compared to non-AI containing regimens. No publication bias was detected by Begg's and Egger's tests for PFS (p = 0.09 and p = 0.32) and OS (p = 0.85 and p = 0.50).

CONCLUSIONS

Our pooled analysis shows that AIs re-challenge offers an improved PFS and OS in the treatment of metastatic CRC patients who relapsed after a first-line bevacizumab-containing therapy. Further prospective clinical trials are still needed to confirm our findings.