Background: In RAS wild type (wt) metastatic colorectal cancer (mCRC) maintenance therapy after induction with fluoropyrimidine (FP)-based cytotoxic therapy (CT) plus anti-EGFR agents is controversial. Methods: Phase II-III randomized trials were included. Maintenance strategies considered were: observation, anti-EGFR or FP monotherapy, FP + anti-EGFR, doublet CT + anti-EGFR. Results: Maintenance with FP + anti-EGFR (HR 0.56, 95% CrI 0.36–0.89) showed the greatest PFS benefit compared to observation, ranking first on SUCRA analysis (96.4%). Considering OS, doublet CT+ anti-EGFR, FP + anti-EGFR and anti-EGFR monotherapy yielded similar results. For PFS, FP + anti-EGFR confirmed to be valuable in BRAF wt patients and left sided tumors. In left sided tumors, the OS benefit of adding CT was limited. FP plus anti-EGFR showed a favourable safety profile compared to doublet CT + anti-EGFR. Conclusions: FP + anti-EGFR can be considered a valuable maintenance option in RAS wt mCRC. EGFR monotherapy can be considered, especially in left-sided tumors.

Mastrantoni, L., Beccia, V., Caira, G., Trovato, G., Calegari, M. A., Basso, M., Salvatore, L., Pozzo, C., Tortora, G., Bria, E., Orlandi, A., Maintenance strategies after anti-EGFR-based induction in metastatic colorectal cancer: A systematic review and bayesian network meta-analysis, <<CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY>>, 2023; 191 (104106): N/A-N/A. [doi:10.1016/j.critrevonc.2023.104106] [https://hdl.handle.net/10807/312430]

Maintenance strategies after anti-EGFR-based induction in metastatic colorectal cancer: A systematic review and bayesian network meta-analysis

Mastrantoni, Luca
Primo
;
Beccia, Viria;Caira, Giulia;Trovato, Giovanni;Calegari, Maria Alessandra;Basso, Maria;Salvatore, Lisa;Pozzo, Carmelo;Tortora, Giampaolo;Bria, Emilio;Orlandi, Armando
Ultimo
2023

Abstract

Background: In RAS wild type (wt) metastatic colorectal cancer (mCRC) maintenance therapy after induction with fluoropyrimidine (FP)-based cytotoxic therapy (CT) plus anti-EGFR agents is controversial. Methods: Phase II-III randomized trials were included. Maintenance strategies considered were: observation, anti-EGFR or FP monotherapy, FP + anti-EGFR, doublet CT + anti-EGFR. Results: Maintenance with FP + anti-EGFR (HR 0.56, 95% CrI 0.36–0.89) showed the greatest PFS benefit compared to observation, ranking first on SUCRA analysis (96.4%). Considering OS, doublet CT+ anti-EGFR, FP + anti-EGFR and anti-EGFR monotherapy yielded similar results. For PFS, FP + anti-EGFR confirmed to be valuable in BRAF wt patients and left sided tumors. In left sided tumors, the OS benefit of adding CT was limited. FP plus anti-EGFR showed a favourable safety profile compared to doublet CT + anti-EGFR. Conclusions: FP + anti-EGFR can be considered a valuable maintenance option in RAS wt mCRC. EGFR monotherapy can be considered, especially in left-sided tumors.
2023
Inglese
Mastrantoni, L., Beccia, V., Caira, G., Trovato, G., Calegari, M. A., Basso, M., Salvatore, L., Pozzo, C., Tortora, G., Bria, E., Orlandi, A., Maintenance strategies after anti-EGFR-based induction in metastatic colorectal cancer: A systematic review and bayesian network meta-analysis, <<CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY>>, 2023; 191 (104106): N/A-N/A. [doi:10.1016/j.critrevonc.2023.104106] [https://hdl.handle.net/10807/312430]
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