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Type: Journal article
Title: The role of biological therapy in metastatic colorectal cancer after first-line treatment: a meta-analysis of randomised trials
Author: Segelov, E.
Chan, D.
Shapiro, J.
Price, T.
Karapetis, C.
Tebbutt, N.
Pavlakis, N.
Citation: British Journal of Cancer, 2014; 111(6):1122-1131
Publisher: Cancer Research UK
Issue Date: 2014
ISSN: 0007-0920
Statement of
E Segelov, D Chan, J Shapiro, T J Price, C S Karapetis, N C Tebbutt and N Pavlakis
Abstract: PURPOSE: Biologic agents have achieved variable results in relapsed metastatic colorectal cancer (mCRC). Systematic meta-analysis was undertaken to determine the efficacy of biological therapy. METHODS: 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. RESULTS: 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. CONCLUSIONS: The use of biologic agents in mCRC after first-line treatment is associated with improved outcomes but increased toxicity.
Keywords: colorectal; biological; meta-analysis
Rights: © 2014 Cancer Research UK. All rights reserved
RMID: 0030013879
DOI: 10.1038/bjc.2014.404
Appears in Collections:Medicine publications

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