Abstract
Whether there is a difference in the efficacy of maintenance treatment for metastatic colorectal cancer (mCRC) between patients who achieve complete response (CR)/partial response (PR) and those with stable disease (SD) after induction treatment is controversial. PubMed, Cochrane Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials, ClinicalTrials.gov, and databases of conferences were queried to identify randomized controlled trials evaluating the efficacy of maintenance treatment for mCRC patients. The search included articles dated from the inception of these resources until June 20, 2017. We estimated hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Network meta-analysis was performed to compare the efficacy of four regimens as maintenance treatment. Three randomized controlled trials comprising 1,301 patients were included in this network meta-analysis. Patients who achieved CR/PR after induction therapy benefited more from maintenance treatment than patients who achieved SD (PFS: HR [CR/PR] 1.50, 95% CI 1.09–2.08, vs. HR [SD] 1.35, 95% CI 1.04–1.74; OS: HR [CR/PR] 1.04, 95% CI 0.94–1.15, vs. HR [SD] 1.03, 95% CI 0.99–1.07). The results of network meta-analysis suggested that chemotherapy alone and observation were inferior to chemotherapy plus bevacizumab as maintenance treatment. Patients with mCRC who achieve CR/PR after induction therapy might benefit more from maintenance treatment than those with SD. Chemotherapy plus bevacizumab was the most appropriate regimen for maintenance treatment.
Highlights
Metastatic colorectal cancer is a common cancer worldwide
The results of network meta-analysis suggested that chemotherapy alone and observation were inferior to chemotherapy plus bevacizumab as maintenance treatment
This meta-analysis suggested that the patients who achieved complete response (CR)/partial response (PR) after the induction treatment benefited more from maintenance treatment than those who showed stable disease (SD) (PFS: hazard ratios (HRs) for CR/PR 1.50 vs. HR for SD 1.35; overall survival (OS): HR for CR/PR 1.04 vs. HR for SD 1.03)
Summary
Metastatic colorectal cancer (mCRC) is a common cancer worldwide. There were an estimated 135,430 new cases and 50,260 deaths in the United States in 2017 [1] and 376,300 new cases and 191,000 deaths in China in 2015 [2]. The treatment of mCRC is complex and the balance between efficacy and toxicities of various regimens should be considered. The results of published papers suggested that maintenance treatment prolonged the progression-free survival (PFS) of mCRC patients, but did not prolong the overall survival (OS). There is heterogeneity in recent analyses of the efficacy of maintenance treatment. Patients with complete response (CR)/partial response (PR) and those with stable disease (SD) after induction therapy were enrolled. There is currently controversy over whether there is a difference in the efficacy of maintenance treatment between patients www.impactjournals.com/oncotarget who achieve CR/PR and those with SD after induction treatment
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