Faculty of Pharmacy, University of Lisbon, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal.
J Cancer Res Clin Oncol. 2020 May;146(5):1321-1334. doi: 10.1007/s00432-020-03167-0. Epub 2020 Mar 6.
Uncertainty exists regarding comparative effectiveness of cetuximab versus bevacizumab in metastatic colorectal cancer (mCRC). We conducted a retrospective head-to-head multi-cohort study comparing clinical outcomes from both antibodies METHODS: Cohorts were defined by treatment line and subgroups by (K)RAS status and tumour sidedness. Among other outcomes, we estimated and compared response rates, progression-free (PFS) and overall survival (OS).
Between January 2010 and April 2018, 311 patients were included. Except for (K)RAS mutation status, baseline characteristics were balanced across treatment groups. In the full analysis of first and second-line cohorts, PFS (first-line: HR = 0.85; 95% CI 0.64 to 1.13; P = 0.26; second-line: HR = 1.16; 95% CI 0.74 to 1.83; P = 0.51) and OS (first-line: HR = 0.83; 95% CI 0.61 to 1.15; P = 0.26; second-line: HR = 0.88; 95% CI 0.56 to 1.38; P = 0.58) were similar between bevacizumab and cetuximab arms. In subgroup analyses of first-line therapy, we found a survival difference favouring bevacizumab in right-sided tumours (PFS: HR = 0.52; 95% CI 0.29 to 0.93; P = 0.025; OS: HR = 0.60; 95% CI 0.32 to 1.12; P = 0.11), but not in left-sided (HR = 1.04; 95% CI 0.75 to 1.46; P = 0.81; OS: HR = 0.94; 95% CI 0.65 to 1.36; P = 0.74), or (K)RAS wild-type tumours (PFS: HR = 0.91; 95% CI 0.60 to 1.40; P = 0.67; OS: HR = 0.79; 95% CI 0.50 to 1.25; P = 0.31). Response rates were similar across treatment groups, except for the subgroup of patients bearing right-sided primaries, where bevacizumab performed substantially better.
This study provides evidence suggesting bevacizumab and cetuximab lead to similar effectiveness outcomes in mCRC, except for right-sided tumours, where cetuximab seemed to show considerably poorer outcomes. Further research is needed to confirm these results.
在转移性结直肠癌（mCRC）中，关于西妥昔单抗与贝伐珠单抗的比较疗效尚存在不确定性。我们进行了一项回顾性头对头多队列研究，比较了两种抗体的临床结果。
根据治疗线和（K）RAS 状态和肿瘤侧别对队列进行了定义。在其他结果中，我们估计并比较了反应率、无进展生存期（PFS）和总生存期（OS）。
2010 年 1 月至 2018 年 4 月期间，共纳入 311 例患者。除（K）RAS 突变状态外，治疗组之间的基线特征平衡。在一线和二线队列的全分析中，PFS（一线：HR=0.85；95%CI0.64 至 1.13；P=0.26；二线：HR=1.16；95%CI0.74 至 1.83；P=0.51）和 OS（一线：HR=0.83；95%CI0.61 至 1.15；P=0.26；二线：HR=0.88；95%CI0.56 至 1.38；P=0.58）在贝伐珠单抗和西妥昔单抗组之间相似。在一线治疗的亚组分析中，我们发现贝伐珠单抗在右侧肿瘤中具有生存优势（PFS：HR=0.52；95%CI0.29 至 0.93；P=0.025；OS：HR=0.60；95%CI0.32 至 1.12；P=0.11），但在左侧肿瘤中无生存优势（HR=1.04；95%CI0.75 至 1.46；P=0.81；OS：HR=0.94；95%CI0.65 至 1.36；P=0.74）或（K）RAS 野生型肿瘤中无生存优势（PFS：HR=0.91；95%CI0.60 至 1.40；P=0.67；OS：HR=0.79；95%CI0.50 至 1.25；P=0.31）。除右侧肿瘤患者亚组外，两组的反应率相似，在该亚组中，贝伐珠单抗的疗效明显更好。
本研究提供的证据表明，贝伐珠单抗和西妥昔单抗在 mCRC 中的疗效相似，除右侧肿瘤外，西妥昔单抗的疗效明显较差。需要进一步的研究来证实这些结果。
