Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis

Although several sequential therapy options are available for treating patients with <i>RAS</i> wild-type (WT) metastatic colorectal cancer (mCRC), the optimal sequence of these therapies is not well established. A systematic review and meta-analysis of 13 randomized controlled trials an...

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Autores principales:	Chih-Chien Wu, Chao-Wen Hsu, Meng-Che Hsieh, Jui-Ho Wang, Min-Chi Chang, Ching-Shiang Yang, Yi-Chia Su
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	sequential therapy patient management <i>RAS</i>-WT mCRC targeted therapy metastatic cancer treatment Medicine R
Acceso en línea:	https://doaj.org/article/a3f36fd933aa44d89a5634388ced8c3f
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spelling	oai:doaj.org-article:a3f36fd933aa44d89a5634388ced8c3f2021-11-11T17:46:52ZOptimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis10.3390/jcm102151662077-0383https://doaj.org/article/a3f36fd933aa44d89a5634388ced8c3f2021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5166https://doaj.org/toc/2077-0383Although several sequential therapy options are available for treating patients with <i>RAS</i> wild-type (WT) metastatic colorectal cancer (mCRC), the optimal sequence of these therapies is not well established. A systematic review and meta-analysis of 13 randomized controlled trials and 4 observational studies were performed, resulting from a search of the Cochrane Library, PubMed, and Embase databases. Overall survival (OS) did not differ significantly in patients with <i>RAS</i>-WT failure who were administered a second-line regimen of changed chemotherapy (CT) plus anti-epidermal growth factor receptor (EGFR) versus only changed CT, changed CT plus bevacizumab versus changed CT plus anti-EGFR, or changed CT versus maintaining CT plus anti-EGFR after first-line therapy with CT, plus bevacizumab. However, OS was significantly different with a second-line regimen that included changed CT plus bevacizumab, versus only changing CT. Analysis of first-line therapy with CT plus anti-EGFR for treatment of <i>RAS</i>-WT mCRC indicated that second-line therapy of changed CT plus an anti-EGFR agent resulted in better outcomes than changing CT without targeted agents. The pooled data study demonstrated that the optimal choice of second-line treatment for improved OS was an altered CT regimen with retention of bevacizumab after first-line bevacizumab failure. The best sequence for first-to-second-line therapy of patients with <i>RAS</i>-WT mCRC was cetuximab-based therapy, followed by a bevacizumab-based regimen.Chih-Chien WuChao-Wen HsuMeng-Che HsiehJui-Ho WangMin-Chi ChangChing-Shiang YangYi-Chia SuMDPI AGarticlesequential therapypatient management<i>RAS</i>-WT mCRCtargeted therapymetastatic cancer treatmentMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5166, p 5166 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	sequential therapy patient management <i>RAS</i>-WT mCRC targeted therapy metastatic cancer treatment Medicine R
spellingShingle	sequential therapy patient management <i>RAS</i>-WT mCRC targeted therapy metastatic cancer treatment Medicine R Chih-Chien Wu Chao-Wen Hsu Meng-Che Hsieh Jui-Ho Wang Min-Chi Chang Ching-Shiang Yang Yi-Chia Su Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis
description	Although several sequential therapy options are available for treating patients with <i>RAS</i> wild-type (WT) metastatic colorectal cancer (mCRC), the optimal sequence of these therapies is not well established. A systematic review and meta-analysis of 13 randomized controlled trials and 4 observational studies were performed, resulting from a search of the Cochrane Library, PubMed, and Embase databases. Overall survival (OS) did not differ significantly in patients with <i>RAS</i>-WT failure who were administered a second-line regimen of changed chemotherapy (CT) plus anti-epidermal growth factor receptor (EGFR) versus only changed CT, changed CT plus bevacizumab versus changed CT plus anti-EGFR, or changed CT versus maintaining CT plus anti-EGFR after first-line therapy with CT, plus bevacizumab. However, OS was significantly different with a second-line regimen that included changed CT plus bevacizumab, versus only changing CT. Analysis of first-line therapy with CT plus anti-EGFR for treatment of <i>RAS</i>-WT mCRC indicated that second-line therapy of changed CT plus an anti-EGFR agent resulted in better outcomes than changing CT without targeted agents. The pooled data study demonstrated that the optimal choice of second-line treatment for improved OS was an altered CT regimen with retention of bevacizumab after first-line bevacizumab failure. The best sequence for first-to-second-line therapy of patients with <i>RAS</i>-WT mCRC was cetuximab-based therapy, followed by a bevacizumab-based regimen.
format	article
author	Chih-Chien Wu Chao-Wen Hsu Meng-Che Hsieh Jui-Ho Wang Min-Chi Chang Ching-Shiang Yang Yi-Chia Su
author_facet	Chih-Chien Wu Chao-Wen Hsu Meng-Che Hsieh Jui-Ho Wang Min-Chi Chang Ching-Shiang Yang Yi-Chia Su
author_sort	Chih-Chien Wu
title	Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis
title_short	Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis
title_full	Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis
title_fullStr	Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis
title_full_unstemmed	Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis
title_sort	optimal sequence and second-line systemic treatment of patients with <i>ras</i> wild-type metastatic colorectal cancer: a meta-analysis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/a3f36fd933aa44d89a5634388ced8c3f
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Optimal Sequence and Second-Line Systemic Treatment of Patients with <i>RAS</i> Wild-Type Metastatic Colorectal Cancer: A Meta-Analysis

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