Bevacizumab as maintenance therapy in patients with metastatic colorectal cancer: A meta-analysis of individual patients’ data from 3 phase III studies

BackgroundThe real impact of bevacizumab maintenance as single agent in metastatic colorectal cancer (mCRC) remains unclear. SAKK-41/06 and PRODIGE-9 failed to demonstrate the non-inferiority superiority versus no maintenance, respectively, while AIO-KRK-0207 showed fluoropyrimidines for time strategy failure.MethodsBibliography electronic databases (PubMed, MEDLINE, Embase, Scopus, Web Science, Cochrane Central Register Controlled Trials) were searched English published clinical trials prospectively randomizing mCRC patients receive or not after first-line chemotherapy plus bevacizumab. Individual patients’ data (IPD) provided by investigators all included trials. Primary end-points progression-free survival (PFS) overall (OS), both from start induction maintenance. Univariate multivariate analyses PFS OS performed.ResultsThree phase III studies - PRODIGE-9, – included. Considering different timing randomization, IPD progressed during starting entered analysis. 909 included, 457 (50%) received Median was 9.6 8.9 months group group, respectively (HR 0.78; 95%CI: 0.68–0.89; p < 0.0001). Subgroups analysis a significant interaction according RAS status (p = 0.048), with benefit limited wild-type patients. No difference terms observed.ConclusionsDespite statistically improvement absolute appears limited. Subgroup shows differential effect favor these results, therapy fluoropyrimidine without first option. Single can be considered selected cases, such cumulative toxicity patient’s refusal, particular