The best strategy for RAS wild-type metastatic colorectal cancer patients in first-line treatment: a classic and Bayesian meta-analysis

Publication date: Available online 9 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Domenico Ciliberto, Nicoletta Staropoli, Francesca Caglioti, Silvia Chiellino, Antonella Ierardi, Rossana Ingargiola, Cirino Botta, Mariamena Arbitrio, Pierpaolo Correale, Pierfrancesco Tassone, Pierosandro Tagliaferri
BackgroundAt present, there is uncertainty on the best systemic treatment in first-line setting for RAS wild-type (WT) metastatic colorectal cancer (mCRC) patients. Indeed, several chemotherapy and biologics combinations showed an improvement on survival. We performed a systematic review with a pair-wise and bayesan meta-analysis to rank the best strategy for these patients.MethodsA systematic literature search through March 2017 was performed to evaluate the association between several treatment combinations and overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicity rate (TR) in RAS WT mCRC patients. Data were extracted from studies and pooled using the random-effect model for pair-wise meta-analyses and bayesan model for network meta-analysis (NMA).ResultsEight studies with a total of 2518 individuals were included in the meta-analyses. Pooled analyses for subgroups stratified by type of schedule and tumor location demonstrated that anti-EGFR + doublet had the best OS when compared to doublet ± bevacizumab (0.767; 95%CI, 0.695–0.846; P < .0001). This benefit is limited to LSCC when compared to a doublet-based schedule and doublet + bevacizumab (HRs, 0.692; 95%CI, 0.596–0.804; P < .001; 0.706; 95%CI, 0.584–0.854; P < .001; respectively). No significant differences are detected in PFS, whereas the cetuximab-based regimens showed the highest ORR and TR. In NMA our ranking showed the best performance for FOLFOX + panitumumab.ConclusionsOur study indicates that FOLFOX + panitumumab has the major probability to provide an improvement of survival with a good safety profile in patients with RAS WT mCRC with an added value from selection based on sidedness.



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