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. 2024 May;56(5):786-794.
doi: 10.1016/j.dld.2023.07.013. Epub 2023 Aug 14.

Second-line treatment strategies for RAS wild-type colorectal cancer: A systematic review and Network Meta-analysis (NMA)

P Di Nardo  1 , D Basile  2 , A Siciliano  3 , G Pelizzari  4 , C Corvaja  5 , S Buriolla  5 , E Ongaro  1 , D Maria Grazia  6 , S K Garattini  4 , L Foltran  1 , M Guardascione  1 , M Casagrande  4 , A Buonadonna  1 , T Prantera  6 , G Aprile  7 , F Puglisi  8
Affiliations

Second-line treatment strategies for RAS wild-type colorectal cancer: A systematic review and Network Meta-analysis (NMA)

P Di Nardo et al. Dig Liver Dis. 2024 May.

Abstract

Background: The optimal strategy for second-line (IIL) treatment in KRAS wt metastatic colorectal cancer (mCRC) is not determined yet.

Methods: A random-effect NMA of phase II/III RCTs was conducted to evaluate IIL treatment for all-RAS wt mCRC, comparing anti-EGFR or anti-VEGF, and chemotherapy (CT).

Results: Overall, 11 RCTs (3613 patients) were included. In KRAS wt patients, PFS was improved with anti-VEGF (HR 0.43) and anti-EGFR (HR 0.63) vs CT. However, anti-VEGF based therapy had the highest likelihood of being ranked as the best treatment in terms of PFS (SUCRA 99.3%) and OS (SUCRA 99.4%). Bevacizumab-based treatment is most likely to be the best treatment in terms of PFS (SUCRA 89.1%) and OS (SUCRA 86.7%).

Conclusions: Second line treatment with anti-VEGF and anti-EGFR improved PFS in mCRC patients, however, anti-VEGF based therapy, particularly CT plus bevacizumab, is the best treatment according to SUCRA in terms of PFS and OS.

Keywords: Metastatic colorectal cancer; Network meta-analysis; RAS wt CRC; Second-line.

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Conflict of interest statement

Conflict of interest F.P. reports receipt of grants/research supports from Astrazeneca, Eisai, and Roche, and receipt of honoraria or consultation fees from Amgen, Astrazeneca, Daichii Sankyo, Celgene, Eisai, Eli Lilly, Exact Sciences, Gilead, GSK, Ipsen, MSD, Novartis, Pierre-Fabre, Pfizer, Roche, Seagen, Takeda, and Viatris.

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