Background: Results from several prospective clinical trials comparing anti-epidermal growth factor receptor (EGFR) therapy and anti-vascular endothelial growth factor (VEGF) therapy plus chemotherapy for wild-type metastatic colorectal cancer (mCRC) have been inconsistent. This meta-analysis aims to investigate the optimal choice for these target agents.
Methods: We searched for clinical trials in both electronic databases from inception until January 2018 and recent conference abstracts to identify prospective clinical studies comparing the efficacy of a VEGF inhibitor (bevacizumab) versus EGFR inhibitors (cetuximab or panitumumab) on wild-type (including its subset ) mCRC. All analyses were conducted using RevMan 5.3 software.
Results: A total of 5 studies were included. EGFR inhibitors were associated with a significant benefit in terms of overall survival (OS) compared with VEGF inhibitors in wild-type or wild-type populations, with hazard ratios (HRs) equal to 0.86 (95% CI: 0.78, 0.95; =0.003) and 0.83 (95% CI: 0.72, 0.95; =0.007), respectively. This survival benefit was limited to the first-line setting. No difference was found for progression-free survival (PFS), whereas the objective response rate (ORR) was significantly increased in the wild-type population (OR: 0.64; 95% CI: 0.50, 0.82; =0.0004). No difference in OS was noted between EGFR inhibitors versus a VEGF inhibitor plus the FOLFIRI regimen, whereas superior survival was noted for EGFR inhibitors plus the mFOLFOX6 regimen versus a VEGF inhibitor (HR: 0.75; 95% CI: 0.57, 0.98; =0.04). PFS was significantly prolonged (HR: 1.48; 95% CI: 1.14, 1.92; =0.003), whereas a trend favoring OS (HR: 1.23; 95% CI: 0.93, 1.63; =0.14) was noted for a VEGF inhibitor in patients with right-sided tumors, with no difference in the ORR (OR: 0.85; 95% CI: 0.52, 1.38; =0.51). However, left-sided tumors exhibited superior OS (HR: 0.71; 95% CI: 0.59, 0.85; =0.0002), PFS (HR: 0.84; 95% CI: 0.72, 0.98; =0.03), and ORR (OR: 0.66; 95% CI: 0.48, 0.92; =0.01) for EGFR inhibitors.
Conclusion: This meta-analysis suggests the superiority of anti-EGFR therapy compared with anti-VEGF therapy for mCRC with wild-type . Primary tumor location should be taken into account in target drug selection. Further research is still needed to confirm which inhibitor may be a better choice when combined with different chemotherapy regimens.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065471 | PMC |
http://dx.doi.org/10.2147/OTT.S168695 | DOI Listing |
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