Anti-angiogenic therapies for metastatic colorectal cancer.

Détails

ID Serval
serval:BIB_2799902E0FBD
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Anti-angiogenic therapies for metastatic colorectal cancer.
Périodique
Cochrane Database of Systematic Reviews
Auteur⸱e⸱s
Wagner A.D., Arnold D., Grothey A.A., Haerting J., Unverzagt S.
ISSN
1469-493X (Electronic)
ISSN-L
1361-6137
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Numéro
3
Pages
CD005392
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Review Publication Status: epublish
Résumé
BACKGROUND: Angiogenesis inhibitors have been developed to block tumour angiogenesis and target vascular endothelial cells. While some of them have already been approved by the health authorities and are successfully integrated into patient care, many others are still under development, and the clinical value of this approach has to be established.
OBJECTIVES: To assess the efficacy and toxicity of targeted anti-angiogenic therapies, in addition to chemotherapy, in patients with metastatic colorectal cancer. Primary endpoints are both progression-free and overall survival. Response rates, toxicity and secondary resectability were secondary endpoints. Comparisons were first-line chemotherapy in combination with angiogenesis inhibitor, to the same chemotherapy without angiogenesis inhibitor; and second-line chemotherapy, to the same chemotherapy without angiogenesis inhibitor.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, as well as proceedings from ECCO, ESMO and ASCO until November 2008. In addition, reference lists from trials were scanned, experts in the field and drug manufacturers were contacted to obtain further information.
SELECTION CRITERIA: Randomized controlled trials on targeted anti-angiogenic drugs in metastatic colorectal cancer (MCRC).
DATA COLLECTION AND ANALYSIS: Data collection and analysis was performed, according to a previously published protocol. Because individual patient data was not provided, aggregate data had to be used for the analysis. Summary statistics for the primary endpoints were hazard ratios (HR's) and their 95% confidence intervals.
MAIN RESULTS: At present, eligible first line trials for this meta-analysis were available for bevacizumab (5 trials including 3101 patients) and vatalanib (1 trial which included 1168 patients). The overall HR s for PFS (0.61, 95% CI 0.45 - 0.83) and OS (0.81, 95% 0.73 - 0.90) for the comparison of first-line chemotherapy, with or without bevacizumab, confirms significant benefits in favour of the patients treated with bevacizumab. However, the effect on PFS shows significant heterogeneity. For second-line chemotherapy, with or without bevacizumab, a benefit in both PFS (HR 0.61, 95% CI 0.51 - 0.73) and OS (HR 0.75, 95% CI 0.63-0.89) was demonstrated in a single, randomized trial. While differences in treatment-related deaths and 60-day mortality were not significant, higher incidences in grade III/IV hypertension, arterial thrombembolic events and gastrointestinal perforations were observed in the patients treated with bevacizumab. For valatanib, currently available data showed a non-significant benefit in PFS and OS.
AUTHORS' CONCLUSIONS: The addition of bevacizumab to chemotherapy of metastatic colorectal cancer prolongs both PFS and OS in first-and second-line therapy.
Mots-clé
Angiogenesis Inhibitors/therapeutic use, Antibodies, Monoclonal/therapeutic use, Antibodies, Monoclonal, Humanized, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Colorectal Neoplasms/blood supply, Colorectal Neoplasms/drug therapy, Combined Modality Therapy/methods, Disease-Free Survival, Humans, Neovascularization, Pathologic/drug therapy, Neovascularization, Pathologic/mortality, Phthalazines/therapeutic use, Pyridines/therapeutic use, Randomized Controlled Trials as Topic, Vascular Endothelial Growth Factor A/antagonists & inhibitors
Pubmed
Web of science
Création de la notice
29/07/2009 8:26
Dernière modification de la notice
20/08/2019 13:06
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