Department of Radiotherapy, University Hospital Essen, Germany.
Cancer Control. 2021 Jan-Dec;28:10732748211033497. doi: 10.1177/10732748211033497.
To assess the relative efficacy and safety of first-line systemic therapies in patients with metastatic colorectal cancer.
A comprehensive literature review was conducted including MEDLINE, Embase, and the Cochrane Central Registry of Controlled Trials for phase II or III randomized controlled trials (RCTs) published up to and including July 15, 2019. We included RCTs in which at least 1 intervention was either chemotherapeutic agents (such as fluorouracil, irinotecan, or oxaliplatin) or antibodies targeting angiogenesis (such as bevacizumab) or agents that act on the epidermal growth factor receptor pathway (such as cetuximab and panitumumab) or studies reported at least one of the following outcomes: overall survival (OS), progression-free survival (PFS), and/or Grade 3 + adverse events (AEs). Using a random effect model, we performed a Bayesian network meta-analysis to analyze the probability of optimal therapeutic regime obtained from direct comparisons with indirect evidences. We estimated hazard ratios for OS and PFS.
A total of 30 RCTs comprising 12,146 mCRC patients with 25 different treatment strategies were included. The triple combination FOLFOXIRI [fluorouracil, leucovorin, oxaliplatin, and irinotecan] plus bevacizumab provided significant survival benefits with improved OS over all other treatments. The network meta-analysis also indicated a significant advantage of using FOLFOXIRI plus bevacizumab in comparison to other treatment strategies for PFS. Besides, FOLFOXIRI plus bevacizumab was associated with the well-tolerated adverse events.
Our study supported the use of FOLFOXIRI plus bevacizumab as the best first-line regimen and potentially effective and safe strategy for the management of patients with mCRC.
评估转移性结直肠癌患者一线系统治疗的相对疗效和安全性。
进行了全面的文献综述，包括 MEDLINE、Embase 和 Cochrane 对照试验中心注册库，纳入截至 2019 年 7 月 15 日发表的 II 期或 III 期随机对照试验（RCT）。我们纳入了至少有 1 种干预措施为化疗药物（如氟尿嘧啶、伊立替康或奥沙利铂）或抗血管生成抗体（如贝伐珠单抗）或作用于表皮生长因子受体途径的药物（如西妥昔单抗和帕尼单抗）的 RCT，或至少报告以下结果之一的研究：总生存期（OS）、无进展生存期（PFS）和/或 3+级不良事件（AE）。使用随机效应模型，我们进行了贝叶斯网络荟萃分析，以分析从直接比较与间接证据中获得的最佳治疗方案的可能性。我们估计了 OS 和 PFS 的风险比。
共纳入 30 项 RCT，包括 12146 例 mCRC 患者和 25 种不同的治疗策略。FOLFOXIRI[氟尿嘧啶、亚叶酸钙、奥沙利铂和伊立替康]加贝伐珠单抗的三联疗法在 OS 方面提供了显著的生存获益，优于其他所有治疗方法。网络荟萃分析还表明，与其他治疗策略相比，FOLFOXIRI 加贝伐珠单抗在 PFS 方面具有显著优势。此外，FOLFOXIRI 加贝伐珠单抗相关的不良反应可耐受。
我们的研究支持使用 FOLFOXIRI 加贝伐珠单抗作为转移性结直肠癌患者一线治疗的最佳方案，这是一种潜在有效和安全的治疗策略。
