Add-on anti-vascularendothelial growth factor agents with the second-line chemotherapy in metastatic colorectal cancer: A meta-analysis of randomized trials.

Abstract

e15059 Background: Whether the survival benefits of anti-VEGF agents in second-line treatment for metastatic colorectal cancer (mCRC) are confounded by clinical factors is unclear. Methods: We searched literatures from PubMed, Embase, Cochrane Library, and conference abstracts through February 2017. Results: Seven randomised controlled trials with total 4931 patients comparing add-on anti-VEGF agents and second-line chemotherapy with chemotherapy alone were included with extracted outcomes from published reports. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Anti-VEGF agents improved PFS and OS (PFS: hazard ratio [HR], 0·78; 95% CI, 0·69–0·88; OS: HR, 0·86; 95% CI, 0·78–0·95) without significant subgroup differences in age(< 65 or ≥65 years, p = 0·815), gender (p = 0·322), ECOG performance status (0 or ≥1, p = 0·514), number of metastases (1 or > 1, p = 0·903), metastasis to the liver only (yes or no, p = 0·713), second-line chemotherapy regimen (oxaliplatin- or irinotecan-based, p = 0·509), and the previous use of bevacizumab (yes or no, p = 0·185). The funnel plots showed symmetrical patterns and the result of Egger’s test was insignificant (PFS, p = 0·220; OS, p = 0·361), indicating no apparent publication bias. Conclusions: For second-line treatment in mCRC, anti-VEGF agents play an important role in PFS and OS in all subgroups of patients.