Ruan Wen-Cong, Che Yue-Ping, Ding Li, Li Hai-Feng
Department of Rehabilitation, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
Comb Chem High Throughput Screen. 2018;21(10):718-724. doi: 10.2174/1386207322666190119162352.
Pre-treated patients with first-line treatment can be offered a second treatment with the aim of improving their poor clinical prognosis. The therapy of metastatic colorectal cancer (CRC) patients who did not respond to first-line therapy has limited treatment options. Recently, many studies have paid much attention to the efficacy of bevacizumab as an adjuvant treatment for metastatic colorectal cancer.
We aimed to evaluate the efficacy and toxicity of bevacizumab plus chemotherapy compared with bevacizumab-naive based chemotherapy as second-line treatment in people with metastatic CRC.
Electronic databases were searched for eligible studies updated to March 2018. Randomized-controlled trials comparing addition of bevacizumab to chemotherapy without bevacizumab in MCRC patients were included, of which, the main interesting results were the efficacy and safety profiles of the addition of bevacizumab in patients with MCRC as second-line therapy.
Five trials were eligible in the meta-analysis. Patients who received the combined bevacizumab and chemotherapy treatment in MCRC as second-line therapy showed a longer overall survival (OS) (OR=0.80,95%CI=0.72-0.89, P<0.0001) and progression-free survival (PFS) (OR=0.69,95%CI=0.61-0.77, P<0.00001). In addition, there was no significant difference in objective response rate (ORR) (RR=1.36,95%CI=0.82-2.24, P=0.23) or severe adverse event (SAE) (RR=1.02,95%CI=0.88-1.19, P=0.78) between bevacizumab-based chemotherapy and bevacizumabnaive based chemotherapy.
Our results suggest that the addition of bevacizumab to the chemotherapy therapy could be an efficient and safe treatment option for patients with metastatic colorectal cancer as second-line therapy and without increasing the risk of an adverse event.
接受过一线治疗的患者可以接受二线治疗，目的是改善其较差的临床预后。对一线治疗无反应的转移性结直肠癌（CRC）患者的治疗选择有限。最近，许多研究都非常关注贝伐单抗作为转移性结直肠癌辅助治疗的疗效。
我们旨在评估在转移性CRC患者中，与单纯化疗相比，贝伐单抗联合化疗作为二线治疗的疗效和毒性。
检索电子数据库，查找截至2018年3月更新的符合条件的研究。纳入比较在MCRC患者中添加贝伐单抗与不添加贝伐单抗的化疗的随机对照试验，其中，主要关注的结果是在MCRC患者中添加贝伐单抗作为二线治疗的疗效和安全性。
五项试验符合荟萃分析的条件。在MCRC中接受贝伐单抗联合化疗作为二线治疗的患者显示出更长的总生存期（OS）（OR=0.80，95%CI=0.72-0.89，P<0.0001）和无进展生存期（PFS）（OR=0.69，95%CI=0.61-0.77，P<0.00001）。此外，基于贝伐单抗的化疗与单纯化疗之间在客观缓解率（ORR）（RR=1.36，95%CI=0.82-2.24，P=0.23）或严重不良事件（SAE）（RR=1.02，95%CI=0.88-1.19，P=0.78）方面没有显著差异。
我们的结果表明，在化疗中添加贝伐单抗可能是转移性结直肠癌患者二线治疗的一种有效且安全的治疗选择，且不会增加不良事件的风险。
