Trifluridine/tipiracil with or Without Bevacizumab in Metastatic Colorectal Cancer: Results of a Systematic Review and Meta-analysis

Overview

Journal Ther Adv Med Oncol

Specialty Oncology

Date 2023 Feb 6

PMID 36743525

Authors

Takayuki Yoshino

Julien Taieb

Yasutoshi Kuboki

Per Pfeiffer

Amit Kumar

Howard S Hochster

Affiliations

Soon will be listed here.

Abstract

Background: Trifluridine/tipiracil plus bevacizumab (FTD/TPI + BEV) has shown efficacy and tolerability in refractory metastatic colorectal cancer (mCRC). Because randomized controlled trial (RCT) data comparing FTD/TPI + BEV with FTD/TPI are lacking, this meta-analysis evaluated outcomes with both regimens.

Data Sources And Methods: Electronic databases, congress proceedings (past 3 years), trial registries, systematic review bibliographies, gray literature, and guidelines through June 2021 were searched for RCTs, non-RCTs, and prospective observational studies involving >20 previously treated patients with mCRC receiving FTD/TPI + BEV or FTD/TPI. Absolute and relative disease control rate (DCR), progression-free survival (PFS), overall survival (OS), adverse event (AE) rates, and discontinuation rates due to AEs were evaluated using fixed-effects and random-effects models. Study quality, heterogeneity, and publication bias were assessed.

Results: In all, 29 of 875 screened publications were selected (26 studies: 5 RCTs, 11 non-RCTs, and 10 prospective observational studies). One RCT compared FTD/TPI + BEV with FTD/TPI. FTD/TPI + BEV FTD/TPI had a higher absolute DCR [64% (6 studies; = 289) 43% (10 studies; = 2809)], median PFS [4.2 (5 studies; = 244) 2.6 (6 studies; = 1781) months], 12-month PFS [9% (5 studies; = 244) 3% (6 studies; = 1781)], median OS [9.8 (5 studies; = 244) 8.1 (6 studies; = 1814) months], and 12-month OS [38% (5 studies; = 244) 32% (6 studies; = 1814)]. Grade ⩾3 febrile neutropenia, asthenia/fatigue, diarrhea, nausea, and vomiting rates were similar (1%-7%). Grade ⩾3 neutropenia rate was higher with FTD/TPI + BEV than with FTD/TPI [43% (6 studies; = 294) 29% (12 studies; = 7139)]. Discontinuation rates due to AEs were similar [8% (5 studies; = 244) and 7% (10 studies; = 3724)]. Low study quality, heterogeneity, and/or publication bias were detected in certain instances.

Conclusion: Despite fewer patients treated with the combination, this meta-analysis consistently suggested that FTD/TPI + BEV provides benefits over FTD/TPI in refractory mCRC and has similar safety, except for more frequent grade ⩾3 neutropenia.

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