- 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.
- Network meta-analysis (12 trials; N=5540).
- Maintenance strategies examined included fluoropyrimidine (FP), FP+Bev, and Bev alone.
- Funding: None; authors disclose industry associations.
- 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.
- Outcome assessors were not blinded in most trials.