Efficacy and Safety of Regorafenib in Combination with Chemotherapy as Second-Line Treatment in Patients with Metastatic
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ORIGINAL RESEARCH
Efficacy and Safety of Regorafenib in Combination with Chemotherapy as Second-Line Treatment in Patients with Metastatic Colorectal Cancer: A Network Meta-Analysis and Systematic Literature Review Xiaoyu Xie . Jianwei Zhang . Huabin Hu . Yue Cai . Zehua Wu . Jiayu Ling . Weiwei Li . Yanhong Deng Received: June 19, 2020 Ó Springer Healthcare Ltd., part of Springer Nature 2020
ABSTRACT Introduction: Although various therapies are available for the treatment of metastatic colorectal cancer (mCRC), there is lack of head-tohead evidence. Recent studies have demonstrated the efficacy of chemotherapy in combination with different biological agents including regorafenib in second-line therapy in patients with mCRC. We conducted a network meta-analysis (NMA) to estimate the relative Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12630152. Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s12325020-01447-2) contains supplementary material, which is available to authorized users. X. Xie J. Zhang H. Hu Y. Cai Z. Wu J. Ling W. Li Y. Deng (&) Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China e-mail: [email protected] Y. Deng Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China Y. Deng Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, People’s Republic of China
efficacy and safety of regorafenib in combination with chemotherapy compared to other biological agents with chemotherapy combinations. Methods: A literature search was conducted in PubMed, Embase, and Cochrane databases to identify all randomized controlled trials (RCTs) evaluating the efficacy and safety of bevacizumab, regorafenib, panitumumab, cetuximab, ramucirumab, conatumumab, ganitumab, and aflibercept in combination with chemotherapy against chemotherapy alone as second-line setting from inception to 7 February 2019 in patients with mCRC. The survival outcomes were analyzed by the frequentist statistical approach (R software, netmeta package) while the level of individual treatment arms was assessed using the Bayesian method (R software, gemtc package). Results: We identified 12 articles involving eight RCTs studies analyzing 6805 patients. The studies compared bevacizumab (3), regorafenib (1), panitumumab (2), cetuximab (3), ramucirumab (1), conatumumab (1), ganitumab (1), and aflibercept (1) against chemotherapy alone as comparator. The progression-free survival (PFS) revealed that regorafenib performed better than aflibercept (HR 0.9631, 95% CI 0.6785–1.367), ganitumab (HR 0.7228, 95% CI 0.3985–1.3109), panitumumab (HR 0.9653, 95% CI 0.6781–1.3742), and ramucirumab (HR 0.9206, 95% CI 0.6504–1.303). Regorafenib performed better than bevacizumab (OR 0.797,
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95% CI 0.328–1.88) in terms of
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