Wania Cristina Silva
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Ellias Magalhaes Abreu Lima
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Vânia Eloísa Araújo
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Jéssica Barreto Ribeiro Santos
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Michael Ruberson Ribeiro Silva
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e15008 Background: Biological agents have presented variable results in the treatment of metastatic colorectal cancer. This study aim to evaluate the effectiveness and safety of the monoclonal antibodies bevacizumab, cetuximab and panitumumab associated or not to chemotherapy in this scenario. Methods: A systematic review and metanaysis was performed based on observational cohort studies published in the following databases: MEDLINE/ Pubmed, LILACS, COCHRANE Library and EMBASE, up to march 2016. The effectiveness outcomes assessed in this trial were overall survival (OS), progression free survival (PFS), pos-progression survival (PPS), response rate based on RECIST criteria and metastasectomy rate. The safety outcome assessed was adverse events. Review Manager 5.3 software was used to perform the data metanalysis and the Newcastle-Ottawa scale evaluated the methodological quality of the observational trials included. Results: 16 trials were included in this metanalysis, 11 evaluating effectiveness and 8 assessing safety. Their methodological quality were considered moderate according to the Newcastle-Ottawa Scale. Basically, this study compared bevacizumab based therapies with no bevacizumab based therapies, once there was no enough data regarding cetuximab and panitumumab. Overall, the group treated with bevacizumab based therapies did better than those in the no bevacizumab group, with OS mean difference (MD) of 4,41 (95% CI 1.75 to 7.07; p = 0.001; I² = 86%) and PFS MD of 3.19 (95% CI 0.42 to 5.96; p = 0,02 I² = 96%). The PPS MD was also statistically significant (MD = 5.90; 95% CI 2.59 to 9.21; p = 0,0005; I² = 82%). When safety was the outcome concerned, the group treated with bevacizumab had more hypertension and gastrointestinal perforation. There was no statistical difference between the groups regarding others side effects. Conclusions: This study showed a potential benefit in using bevacizumab as a part of the treatment of mCRC. Bevacizumab improved PFS, OS and PPS and these differences were statistically significant. However, the drug also increased treatment related toxicities.
PIK3CA exon 20 mutations as a potential biomarker for resistance to anti-EGFR monoclonal antibodies in KRAS wild-type metastatic colorectal cancer: a systematic review and meta-analysis
