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Title: The role of biological therapy in metastatic colorectal cancer after first-line treatment: a meta-analysis of randomised trials.
Austin Authors: Segelov, E;Chan, David L;Shapiro, J;Price, Timothy J;Karapetis, C S;Tebbutt, Niall C ;Pavlakis, N
Affiliation: Flinders University and Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Bedford Park, SA, 5042, Australia
The Queen Elizabeth Hospital and University of Adelaide, Woodville South, SA 5011, Australia
Monash University and Cabrini Hospital, Melbourne, VIC 3800, Australia
Austin Health, VIC 3084, Australia
Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
Issue Date: 29-Jul-2014
Publication information: British Journal of Cancer 2014; 111(6): 1122-31
Abstract: Biologic agents have achieved variable results in relapsed metastatic colorectal cancer (mCRC). Systematic meta-analysis was undertaken to determine the efficacy of biological therapy.Major databases were searched for randomised studies of mCRC after first-line treatment comparing (1) standard treatment plus biologic agent with standard treatment or (2) standard treatment with biologic agent with the same treatment with different biologic agent(s). Data were extracted on study design, participants, interventions and outcomes. Study quality was assessed using the MERGE criteria. Comparable data were pooled for meta-analysis.Twenty eligible studies with 8225 patients were identified. The use of any biologic therapy improved overall survival with hazard ratio (HR) 0.87 (95% confidence interval (CI) 0.82-0.91, P<0.00001), progression-free survival (PFS) with HR 0.71 (95% CI 0.67-0.74, P<0.0001) and overall response rate (ORR) with odds ratio (OR) 2.38 (95% CI 2.03-2.78, P<0.00001). Grade 3/4 toxicity was increased with OR 2.34. Considering by subgroups, EGFR inhibitors (EGFR-I) in the second-line setting and anti-angiogenic therapies (both in second-line and third-line and beyond settings) all improved overall survival, PFS and ORR. EGFR-I in third-line settings improved PFS and ORR but not OS.The use of biologic agents in mCRC after first-line treatment is associated with improved outcomes but increased toxicity.
Gov't Doc #: 25072258
DOI: 10.1038/bjc.2014.404
Type: Journal Article
Subjects: Angiogenesis Inhibitors.adverse effects.therapeutic use
Antibodies, Monoclonal.adverse effects.therapeutic use
Biological Therapy.adverse effects
Colorectal Neoplasms.drug therapy.pathology
Disease-Free Survival
Randomized Controlled Trials as Topic
Receptor, Epidermal Growth Factor.antagonists & inhibitors
Receptors, Vascular Endothelial Growth Factor.antagonists & inhibitors
Vascular Endothelial Growth Factor A.antagonists & inhibitors
Appears in Collections:Journal articles

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