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

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

doi:10.1016/j.critrevonc.2023.104106

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

Crit Rev Oncol Hematol. 2023 Nov:191:104106. doi: 10.1016/j.critrevonc.2023.104106. Epub 2023 Sep 1.

Authors

Affiliations

¹ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: l.mastrantoni@hotmail.it.
² Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: viria.beccia01@icatt.it.
³ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: giulia.caira01@icatt.it.
⁴ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: giovanni.trovato1995@gmail.com.
⁵ Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy. Electronic address: mariaalessandra.calegari@policlinicogemelli.it.
⁶ Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy. Electronic address: michele.basso@policlinicogemelli.it.
⁷ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy. Electronic address: lisa.salvatore@policlinicogemelli.it.
⁸ Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy. Electronic address: carmelo.pozzo@policlinicogemelli.it.
⁹ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy. Electronic address: giampaolo.tortora@unicatt.it.
¹⁰ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy. Electronic address: emilio.bria@unicatt.it.
¹¹ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: armando.orlandi@policlinicogemelli.it.

PMID: 37659764
DOI: 10.1016/j.critrevonc.2023.104106

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.

Keywords: Anti-EGFR; Cetuximab; Maintenance therapy; Meta-analysis; Panitumumab.

Publication types

Review