In metastatic CRC, fluoropyrimidine-based maintenance therapy looks best

  • Sonbol MB & al.
  • JAMA Oncol
  • 19 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Fluoropyrimidine-based maintenance had the best odds of improving PFS in metastatic colorectal cancer (CRC).

Why this matters

  • Fluoropyrimidine-based maintenance strategy with or without bevacizumab (Bev) should be preferred over continuous induction therapy, but observation is also an acceptable choice.
  • Maintenance with Bev alone is not an acceptable approach.

Study design

  • Network meta-analysis (12 trials; N=5540).
  • Maintenance strategies examined included fluoropyrimidine (FP), FP+Bev, and Bev alone.
  • Funding: None; authors disclose industry associations.

Key results

  • Continuation of full cytotoxic chemotherapy until progression had no benefit over observation or maintenance therapy with respect to PFS or OS.
  • Based on a surface under the cumulative ranking analysis, maintenance therapy had a PFS benefit compared with observation (HR, 0.58; 95% CI, 0.43-0.77), but did not improve OS (HR, 0.91; 95% CI, 0.83-1.01).
  • The greatest probability of increasing PFS was found with FP+Bev (99.8%), followed by FP (67.1%).
  • The greatest probability of increasing OS was found with FP (81.3%), followed by FP+Bev (73.2%).
  • FP was more likely to result in progression delay than observation or Bev alone.

Limitations

  • Outcome assessors were not blinded in most trials.