Aflibercept-Based and Bevacizumab-Based Second Line Regimens in Patients with Metastatic Colorectal Cancer: Propensity Score Weighted-Analysis from a Multicenter Cohort

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-01-02 DOI:10.1016/j.clcc.2024.12.007

Jessica Lucchetti , Lorenzo Angotti , Alessandro Parisi , Michele Basso , Mariam Grazia Polito , Federica Zoratto , Emanuela Di Giacomo , Daniele Nitti , Alessandro Minelli , Lisa Salvatore , Maria Alessandra Calegari , Federica Lo Prinzi , Donatello Gemma , Carlo Signorelli , Margherita Veroli , Annunziato Anghelone , Luca Galbato Muscio , Barbara Di Cocco , Giorgio Trombetta , Cristina Morelli , Giuseppe Tonini

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Abstract

Background

Both aflibercept and bevacizumab-based regimens are available II-line treatment options for patients with metastatic colorectal cancer (mCRC). However, no head-to-head trials established the optimal anti-angiogenic strategy for this setting.

Methods

We launched a multicenter, retrospective, observational study to assess and compare clinical efficacy of II-line treatments for patients with mCRC. Patients with KRAS/NRAS/BRAF-wild type and KRAS/NRAS mutant tumors were also analyzed separately.

Findings

348 patients were included, of whom 153 and 195 were treated with bevacizumab- and aflibercept-based regimens, respectively. Patients treated with aflibercept showed an increased risk of death (corrected [co]-HR 1.92, 95 %CI: 1.37–2.68), of disease progression/death (co-HR 1.43, 95 %CI: 1.12–1.82) and a decreased objective response rate (ORR) (21.5 % vs 34.7 %, p=0.007) in comparison to bevacizumab. Patients treated with II-line bevacizumab were more frequently treated in the third line setting after disease progression (91.1 % vs 68.5 %, p<0.0001). In the KRAS/NRAS mutant cohort, treatment with bevacizumab was associated with longer overall survival (OS) (18.0 months vs 12.5 months, p=0.0069), but similar progression free survival (PFS) (p=0.32) and ORR (p=0.57). In the KRAS/NRAS, BRAF wild type cohort, patients treated with bevacizumab achieved longer OS (20.2 months vs 10.6 months, p=0.013), PFS (8.4 months vs 3.7 months, p=0.0002), and higher ORR (48.6 % vs 15.0 %, p=0.0016), compared to those treated with aflibercept. The results were independently confirmed with inverse probability of treatment weighting and with fixed multivariable Cox-regressions.

Conclusion

These findings support the use of bevacizumab-based over aflibercept-based regimens as II-line treatment in mCRC, especially in KRAS/NRAS and BRAF wild type tumors.

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转移性结直肠癌患者以阿非利赛为基础和以贝伐单抗为基础的二线治疗方案：多中心队列倾向评分加权分析

背景：对于转移性结直肠癌（mCRC）患者，阿非利西普和贝伐单抗方案都是可用的二线治疗方案。然而，在这种情况下，没有正面试验确定最佳的抗血管生成策略。方法：我们开展了一项多中心、回顾性、观察性研究，以评估和比较ii线治疗对mCRC患者的临床疗效。KRAS/NRAS/ braf -野生型和KRAS/NRAS突变型肿瘤患者也分别进行了分析。研究结果：纳入348例患者，其中分别有153例和195例患者接受了基于贝伐单抗和阿普利赛的治疗方案。与贝伐单抗相比，阿非利西普治疗的患者死亡风险（校正[co]-HR 1.92, 95 %CI: 1.37-2.68）、疾病进展/死亡风险（校正[co]-HR 1.43, 95 %CI: 1.12-1.82）增加，客观缓解率（ORR）降低（21.5% % vs 34.7 %,p=0.007）。接受贝伐单抗ii线治疗的患者在疾病进展后更频繁地接受三线治疗（91.1 % vs 68.5 %）。结论：这些发现支持使用基于贝伐单抗的方案作为mCRC的ii线治疗，特别是在KRAS/NRAS和BRAF野生型肿瘤中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.