二线治疗策略在 RAS 野生型结直肠癌中的应用：系统评价与网络荟萃分析（NMA）。
Second-line treatment strategies for RAS wild-type colorectal cancer: A systematic review and Network Meta-analysis (NMA).
机构信息
Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy.
Unit of Medical Oncology, Lamezia Terme Hospital, Italy.
出版信息
Dig Liver Dis. 2024 May;56(5):786-794. doi: 10.1016/j.dld.2023.07.013. Epub 2023 Aug 14.
BACKGROUND
The optimal strategy for second-line (IIL) treatment in KRAS wt metastatic colorectal cancer (mCRC) is not determined yet.
METHODS
A random-effect NMA of phase II/III RCTs was conducted to evaluate IIL treatment for all-RAS wt mCRC, comparing anti-EGFR or anti-VEGF, and chemotherapy (CT).
RESULTS
Overall, 11 RCTs (3613 patients) were included. In KRAS wt patients, PFS was improved with anti-VEGF (HR 0.43) and anti-EGFR (HR 0.63) vs CT. However, anti-VEGF based therapy had the highest likelihood of being ranked as the best treatment in terms of PFS (SUCRA 99.3%) and OS (SUCRA 99.4%). Bevacizumab-based treatment is most likely to be the best treatment in terms of PFS (SUCRA 89.1%) and OS (SUCRA 86.7%).
CONCLUSIONS
Second line treatment with anti-VEGF and anti-EGFR improved PFS in mCRC patients, however, anti-VEGF based therapy, particularly CT plus bevacizumab, is the best treatment according to SUCRA in terms of PFS and OS.
背景
KRAS 野生型转移性结直肠癌（mCRC）二线（IIL）治疗的最佳策略尚未确定。
方法
对 II 期/III 期 RCT 进行随机效应 NMA，以评估所有 RAS 野生型 mCRC 的 IIL 治疗，比较抗 EGFR 或抗 VEGF 与化疗（CT）。
结果
共纳入 11 项 RCT（3613 例患者）。在 KRAS 野生型患者中，与 CT 相比，抗 VEGF（HR 0.43）和抗 EGFR（HR 0.63）可改善 PFS。然而，抗 VEGF 为基础的治疗在 PFS（SUCRA 99.3%）和 OS（SUCRA 99.4%）方面最有可能被评为最佳治疗。贝伐珠单抗为基础的治疗在 PFS（SUCRA 89.1%）和 OS（SUCRA 86.7%）方面最有可能是最佳治疗。
结论
抗 VEGF 和抗 EGFR 的二线治疗改善了 mCRC 患者的 PFS，但根据 SUCRA，抗 VEGF 为基础的治疗，特别是 CT 加贝伐珠单抗，在 PFS 和 OS 方面是最佳治疗。
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