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Review
. 2017 Dec 21;9(15):12479-12486.
doi: 10.18632/oncotarget.23549. eCollection 2018 Feb 23.

Who will benefit more from maintenance therapy of metastatic colorectal cancer?

Mingyi Zhou  1 , Lingyu Fu  2 , Jingdong Zhang  3
Affiliations
Review

Who will benefit more from maintenance therapy of metastatic colorectal cancer?

Mingyi Zhou et al. Oncotarget. .

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.

Keywords: complete or partial response; maintenance treatment; metastatic colorectal cancer; network meta-analysis; stable disease.

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Conflict of interest statement

CONFLICTS OF INTEREST There is no conflicts of interest.

Figures

Figure 1
Figure 1. Literature search and selection of studies
Abbreviation: RCT, randomized controlled trial.
Figure 2
Figure 2. Network of the comparisons included in the network meta-analysis
The sizes of the nodes are proportional to the numbers of patients (in parentheses) randomized to receive the treatment. The width of the lines is proportional to the number of trials (next to the line) comparing the connected treatments.
Figure 3
Figure 3
Pooled HRs of PFS for patients with CR/PR after induction therapy (A) and those with SD (B) and pooled HRs of OS for patients with CR/PR after induction therapy (C) and those with SD (D) determined using direct meta-analysis. Abbreviations: Bev, Bevacizumab; HR, hazard ratio; PFS, progression-free survival; OS, overall survival; CR, complete response; PR, partial response; SD, stable disease.
Figure 4
Figure 4
Pooled HRs of PFS for patients with CR/PR after induction therapy (A) and those with SD (B) and pooled HRs of OS for patients with CR/PR after induction therapy (C) and those with SD (D) determined using network meta-analysis. Abbreviations: Bev, Bevacizumab; HR, hazard ratio; PFS, progression-free survival; OS, overall survival; CR, complete response; PR, partial response; SD, stable disease.
See this image and copyright information in PMC

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