Shaotang Li1, Pan Chi. 1. Postgraduate School, Fujian Medical University, Fuzhou, Fujian, Peoples Republic of China.
Abstract
OBJECTIVE: To assess the efficacy and safety of first-line standard chemotherapy plus bevacizumab in metastatic colorectal cancer and to explore how to optimize therapeutic efficacy. DESIGN: First, meta-analysis and pooled analysis of three randomized, controlled trials were used to compare response rate (RR), progression-free survival (PFS), overall survival (OS), and grade 3 or 4 adverse events (G3/4AEs) of chemotherapy plus bevacizumab (n = 1169) with those of chemotherapy alone (n = 1148). Second, using six different regimens plus bevacizumab, the Spearman method was used to analyze the correlation between these regimens and OS. Finally, one-way ANOVA was used to compare OS in these regimens. RESULTS: Overall, chemotherapy plus bevacizumab increased RR by 3.8%, prolonged PFS by 3.0 months and OS by 3.3 months, and increased G3/4AEs by 7.6%. Significant differences were found in PFS (hazard ratio [HR] = 0.65; p = 0.000), OS (HR = 0.79; p = 0.000), and G3/4AEs (risk ratio = 1.12; p = 0.006). However, no statistical difference was found in RR (odds ratio = 1.32; p = 0.17). The optimal regimens with regard to mean OS were capecitabine and irinotecan (CAPIRI) plus bevacizumab (24.00 months) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab (23.97 months). CONCLUSION: First-line standard chemotherapy plus bevacizumab conferred a significant improvement in OS. In combination with bevacizumab, both CAPIRI and FOLFOX are favorable regimens, though further studies are needed to confirm these results.
OBJECTIVE: To assess the efficacy and safety of first-line standard chemotherapy plus bevacizumab in metastatic colorectal cancer and to explore how to optimize therapeutic efficacy. DESIGN: First, meta-analysis and pooled analysis of three randomized, controlled trials were used to compare response rate (RR), progression-free survival (PFS), overall survival (OS), and grade 3 or 4 adverse events (G3/4AEs) of chemotherapy plus bevacizumab (n = 1169) with those of chemotherapy alone (n = 1148). Second, using six different regimens plus bevacizumab, the Spearman method was used to analyze the correlation between these regimens and OS. Finally, one-way ANOVA was used to compare OS in these regimens. RESULTS: Overall, chemotherapy plus bevacizumab increased RR by 3.8%, prolonged PFS by 3.0 months and OS by 3.3 months, and increased G3/4AEs by 7.6%. Significant differences were found in PFS (hazard ratio [HR] = 0.65; p = 0.000), OS (HR = 0.79; p = 0.000), and G3/4AEs (risk ratio = 1.12; p = 0.006). However, no statistical difference was found in RR (odds ratio = 1.32; p = 0.17). The optimal regimens with regard to mean OS were capecitabine and irinotecan (CAPIRI) plus bevacizumab (24.00 months) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab (23.97 months). CONCLUSION: First-line standard chemotherapy plus bevacizumab conferred a significant improvement in OS. In combination with bevacizumab, both CAPIRI and FOLFOX are favorable regimens, though further studies are needed to confirm these results.
Authors: Herbert I Hurwitz; Niall C Tebbutt; Fairooz Kabbinavar; Bruce J Giantonio; Zhong-Zhen Guan; Lada Mitchell; Daniel Waterkamp; Josep Tabernero Journal: Oncologist Date: 2013-07-23
Authors: Mark E Bensink; Scott D Ramsey; Tracy Battaglia; Kevin Fiscella; Thelma C Hurd; June M McKoy; Steven R Patierno; Peter C Raich; Eric E Seiber; Victoria Warren-Mears; Elizabeth Whitley; Electra D Paskett; S Mandelblatt Journal: Cancer Date: 2013-10-25 Impact factor: 6.860