Mastrantoni Luca, Beccia Viria, Caira Giulia, Trovato Giovanni, Calegari Maria Alessandra, Basso Michele, Salvatore Lisa, Pozzo Carmelo, Tortora Giampaolo, Bria Emilio, Orlandi Armando
Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.
Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy.
Crit Rev Oncol Hematol. 2023 Nov;191:104106. doi: 10.1016/j.critrevonc.2023.104106. Epub 2023 Sep 1.
In RAS wild type (wt) metastatic colorectal cancer (mCRC) maintenance therapy after induction with fluoropyrimidine (FP)-based cytotoxic therapy (CT) plus anti-EGFR agents is controversial.
Phase II-III randomized trials were included. Maintenance strategies considered were: observation, anti-EGFR or FP monotherapy, FP + anti-EGFR, doublet CT + anti-EGFR.
Maintenance with FP + anti-EGFR (HR 0.56, 95% CrI 0.36-0.89) showed the greatest PFS benefit compared to observation, ranking first on SUCRA analysis (96.4%). Considering OS, doublet CT+ anti-EGFR, FP + anti-EGFR and anti-EGFR monotherapy yielded similar results. For PFS, FP + anti-EGFR confirmed to be valuable in BRAF wt patients and left sided tumors. In left sided tumors, the OS benefit of adding CT was limited. FP plus anti-EGFR showed a favourable safety profile compared to doublet CT + anti-EGFR.
FP + anti-EGFR can be considered a valuable maintenance option in RAS wt mCRC. EGFR monotherapy can be considered, especially in left-sided tumors.
在RAS野生型（wt）转移性结直肠癌（mCRC）中，基于氟嘧啶（FP）的细胞毒性疗法（CT）联合抗EGFR药物诱导治疗后的维持治疗存在争议。
纳入II-III期随机试验。考虑的维持策略包括：观察、抗EGFR或FP单药治疗、FP +抗EGFR、双联CT +抗EGFR。
与观察相比，FP +抗EGFR维持治疗（HR 0.56，95% CrI 0.36-0.89）显示出最大的无进展生存期（PFS）获益，在SUCRA分析中排名第一（96.4%）。考虑总生存期（OS），双联CT +抗EGFR、FP +抗EGFR和抗EGFR单药治疗产生相似结果。对于PFS，FP +抗EGFR在BRAF wt患者和左侧肿瘤中被证实具有价值。在左侧肿瘤中，添加CT的OS获益有限。与双联CT +抗EGFR相比，FP加抗EGFR显示出良好的安全性。
FP +抗EGFR可被视为RAS wt mCRC中有价值的维持治疗选择。可考虑抗EGFR单药治疗，尤其是在左侧肿瘤中。
