The addition of bevacizumab in the first-line treatment for metastatic colorectal cancer: an updated meta-analysis of randomized trials
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Hyun Joo Jang1, Bum Jun Kim2,3, Jung Han Kim2 and Hyeong Su Kim2
1Division of Gastroenterology, Department of Internal Medicine, Dongtan Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Hwasung 18450, Republic of Korea
2Division of Hemato-Oncology, Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul 07441, Republic of Korea
3Department of Internal Medicine, Korean Armed Forces Capital Hospital, The Armed Forces Medical Command, Sungnam 13574, Republic of Korea
Jung Han Kim, email: [email protected]
Hyeong Su Kim, email: [email protected]
Keywords: colorectal cancer, bevacizumab, irinotecan, meta-analysis
Received: May 16, 2017 Accepted: August 06, 2017 Published: August 17, 2017
Bevacizumab has shown survival benefits when added to chemotherapy in patients with metastatic colon cancer (mCRC). However, the efficacy of bevacizumab may depend on the accompanying chemotherapeutic regimen. We performed this meta-analysis to examine the impact of the choice of chemotherapy regimen on the survival benefits of bevacizumab in the first-line treatment for patients with mCRC. Electric databases were searched for eligible randomized trials. From 9 studies, 3,710 patients with mCRC were included in the meta-analysis of hazard ratios (HRs) for progression-free survival (PFS) or overall survival (OS). Compared with chemotherapy alone, the addition of bevacizumab to chemotherapy significantly prolonged PFS (HR = 0.66 [95% confidence interval (CI), 0.55–0.77], P < 0.0001) and OS (HR = 0.84 [95% CI, 0.77–0.92], P = 0.0001). In the subgroup analysis according to the chemotherapeutic regimens, bevacizumab showed both PFS (HR = 0.57 [95% CI, 0.41–0.77], P = 0.0004) and OS (HR = 0.79 [95% CI, 0.67–0.93], P = 0.004) advantages only in combination with irinotecan-based regimen. In conclusion, this meta-analysis confirms that the addition of bevacizumab to chemotherapy significantly prolongs PFS and OS in the first-line treatment for mCRC. The subgroup analyses suggest that irinotecan-based regimen may be a better partner of bevacizumab in terms of both PFS and OS.
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