贝伐珠单抗联合化疗作为右半转移性结直肠癌一线治疗的最佳选择：一线临床试验的荟萃分析。
Chemotherapy plus bevacizumab as an optimal first-line therapeutic treatment for patients with right-sided metastatic colon cancer: a meta-analysis of first-line clinical trials.
机构信息
Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Clinical Laboratory, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
出版信息
ESMO Open. 2020 Mar;4(Suppl 2). doi: 10.1136/esmoopen-2019-000605.
BACKGROUND
Monoclonal antibodies of anti-epidermal growth factor receptor (EGFR) have been recommended as first-line therapy for patients with left-sided metastatic colorectal cancer (mCRC) with wild-type . The effect of tumour laterality on antivascular endothelial growth factor antibody and how to optimise targeted therapies for the right-sided cases remain controversial.
PATIENTS AND METHODS
A comprehensive meta-analysis enrolling 16 first-line clinical trials was performed to evaluate the efficacy of chemotherapy alone and chemotherapy plus targeted therapies for patients with mCRC with right primary tumour site, and we validated the results in metastatic setting (14 trials containing 4306 patients with unresectable mCRC).
RESULTS
Here, we found that progression-free survival (PFS) (combined HR 1.30, 95% CI 1.17 to 1.44) and overall survival (OS) (combined HR 1.46, 95% CI 1.32 to 1.62) of the right-sided patients were significantly inferior to the left-sided individuals receiving chemotherapy alone in overall population, regardless of race. Similar results were also observed in metastatic setting. OS of patients with left-sided mCRC receiving chemotherapy plus bevacizumab was superior to the right-sided individuals (combined median survival ratio (MSR)=1.23, 95% CI 1.08 to 1.39 for overall population; combined MSR=1.23, 95% CI 1.05 to 1.45 for metastatic setting), especially for wild-type and mixed population. Moreover, the right-sided patients benefited more from chemotherapy plus bevacizumab comparing with chemotherapy alone in both overall population and metastatic setting. Importantly, the -wild right-sided patients achieved longer PFS (combined HR 0.67, 95% CI 0.52 to 0.88) and OS (combined HR 0.74, 95% CI 0.56 to 0.98) from chemotherapy plus bevacizumab comparing with chemotherapy associated with anti-EGFR agents.
CONCLUSIONS
Patients with right-sided mCRC show impaired chemosensitivity, and chemotherapy plus bevacizumab can be an optimal first-line therapeutic regimen for the wild patients with right-sided mCRC.
背景
抗表皮生长因子受体（EGFR）单克隆抗体已被推荐为野生型左侧转移性结直肠癌（mCRC）患者的一线治疗药物。肿瘤侧位对血管内皮生长因子抗体的影响以及如何优化右侧病例的靶向治疗仍存在争议。
方法
对 16 项一线临床试验进行了全面的荟萃分析，以评估单独化疗和化疗联合靶向治疗对原发肿瘤位于右侧的 mCRC 患者的疗效，我们在转移性环境中验证了这些结果（包含 4306 例不可切除的 mCRC 的 14 项试验）。
结果
在这里，我们发现无论种族如何，右侧患者的无进展生存期（PFS）（合并 HR 1.30，95%CI 1.17 至 1.44）和总生存期（OS）（合并 HR 1.46，95%CI 1.32 至 1.62）明显低于单独接受化疗的左侧患者。在转移性环境中也观察到了类似的结果。接受化疗联合贝伐单抗治疗的左侧 mCRC 患者的 OS 优于右侧患者（总体人群的合并中位生存率比（MSR）=1.23，95%CI 1.08 至 1.39；转移性人群的合并 MSR=1.23，95%CI 1.05 至 1.45），尤其是野生型和混合人群。此外，右侧患者在总体人群和转移性环境中从化疗联合贝伐单抗中获益多于单独化疗。重要的是，与化疗联合抗 EGFR 药物相比，-野生右侧患者从化疗联合贝伐单抗中获得了更长的 PFS（合并 HR 0.67，95%CI 0.52 至 0.88）和 OS（合并 HR 0.74，95%CI 0.56 至 0.98）。
结论
右侧 mCRC 患者表现出较差的化疗敏感性，化疗联合贝伐单抗可能是右侧野生型 mCRC 患者的最佳一线治疗方案。
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