PMID- 37810981
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231031
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 13
DP  - 2023
TI  - Comparison of the efficacy and safety of third-line treatments for metastatic 
      colorectal cancer: a systematic review and network meta-analysis.
PG  - 1269203
LID - 10.3389/fonc.2023.1269203 [doi]
LID - 1269203
AB  - BACKGROUND: The objective of this study is to evaluate the efficacy and safety of 
      different third-line treatment regimens for metastatic colorectal cancer (mCRC) 
      through a comprehensive analysis and network meta-analysis (NMA). Additionally, 
      the study aims to provide guidance on selecting appropriate third-line systemic 
      treatment regimens for patients with mCRC. METHODS: We conducted a search of the 
      PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled 
      Trials databases from January 1, 2005, to May 20, 2023, to include phase II/III 
      randomized clinical trials (RCTs) of third-line treatments for mCRC. The primary 
      outcome assessed in the NMA was median overall survival (mOS), and other outcomes 
      included median progression-free survival (mPFS), disease control rate (DCR), and 
      grade 3 or higher adverse events (>/=3AEs). RESULTS: Ultimately, nine phase II/III 
      RCTs involving five treatment regimens were included in this study. 
      Trifluridine/tipiracil (TAS-102) plus bevacizumab (hazard ratio [HR] 0.41, 95% 
      credible interval [CrI] 0.32-0.52) was found to be the most effective treatment 
      for mOS compared to best supportive care (BSC). TAS-102 plus bevacizumab also 
      significantly improved mPFS compared to BSC (HR 0.20, 95% CrI 0.16-0.25). In 
      terms of adverse events (AEs), TAS-102 (RR 0.52, 95% CrI 0.35-0.74) had a lower 
      incidence of >/=3AEs compared to fruquintinib, but fruquintinib (RR 1.79, 95% CrI 
      1.10-3.11) showed better improvement in DCR than TAS-102. Subgroup analysis using 
      the Bayesian surface under the cumulative ranking curve (SUCRA) ranked the 
      regimens based on the OS benefit. The results indicated that TAS-102 plus 
      bevacizumab ranked first across age, gender, Eastern Cooperative Oncology Group 
      performance status (ECOG PS), and time from initial diagnosis of metastatic 
      disease to randomization. CONCLUSION: TAS-102, fruquintinib, TAS-102 plus 
      bevacizumab, the regorafenib standard dose regimen (regorafenib), and the 
      regorafenib dose-escalation regimen (regorafenib 80+) all demonstrated improved 
      OS and PFS compared to BSC in mCRC patients. However, TAS-102 plus bevacizumab 
      may be the optimal choice for third-line treatment in mCRC patients. SYSTEMATIC 
      REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php, 
      CRD42023434929.
CI  - Copyright (c) 2023 Gao, Tang, Hu, Peng, Li and Liu.
FAU - Gao, Loulu
AU  - Gao L
AD  - School of Clinical Medicine, Weifang Medical University, Weifang, China.
AD  - Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First 
      Medical University and Shandong Academy of Medical Sciences, Jinan, China.
FAU - Tang, Lin
AU  - Tang L
AD  - Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First 
      Medical University and Shandong Academy of Medical Sciences, Jinan, China.
AD  - Department of Oncology, Shandong First Medical University and Shandong Academy of 
      Medical Sciences, Jinan, China.
FAU - Hu, Zixuan
AU  - Hu Z
AD  - School of Clinical Medicine, Weifang Medical University, Weifang, China.
FAU - Peng, Jieqiong
AU  - Peng J
AD  - Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First 
      Medical University and Shandong Academy of Medical Sciences, Jinan, China.
FAU - Li, Xiaoqian
AU  - Li X
AD  - Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First 
      Medical University and Shandong Academy of Medical Sciences, Jinan, China.
FAU - Liu, Bo
AU  - Liu B
AD  - Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First 
      Medical University and Shandong Academy of Medical Sciences, Jinan, China.
LA  - eng
PT  - Systematic Review
DEP - 20230921
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC10552753
OTO - NOTNLM
OT  - colorectal cancer
OT  - neoplasm metastasis
OT  - network meta-analysis (NMA)
OT  - third-line
OT  - treatment
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/10/09 12:43
MHDA- 2023/10/09 12:44
PMCR- 2023/01/01
CRDT- 2023/10/09 06:11
PHST- 2023/07/29 00:00 [received]
PHST- 2023/08/28 00:00 [accepted]
PHST- 2023/10/09 12:44 [medline]
PHST- 2023/10/09 12:43 [pubmed]
PHST- 2023/10/09 06:11 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2023.1269203 [doi]
PST - epublish
SO  - Front Oncol. 2023 Sep 21;13:1269203. doi: 10.3389/fonc.2023.1269203. eCollection 
      2023.