Clinical Oncology

[Beyond second line therapy in patients with metastatic colorectal cancer: a systematic review]

D. Arnold1,2, G. W. Prager3, A. Quintela1, A. Stein4, S. Moreno Vera5, J. Taieb6

AUGUST 30, 2019

Clinical Oncology - 2019;6(03)

[Background: The optimal chemotherapeutic regimen for use beyond the second line for patients with metastatic colorectal cancer (mCRC) remains unclear. Materials and methods: We systematically searched the Cochrane Database of Systematic Reviews, EMBASE and Medline for records published between January 2002 and May 2017, and cancer congress databases for records published between January 2014 and June 2017. Eligible studies evaluated the effi cacy, safety and patient-reported outcomes of monotherapies or combination therapies at any dose and number of treatment cycles for use beyond the second line in patients with mCRC. Studies were assessed for design and quality, and a qualitative data synthesis was conducted to understand the impact of treatment on overall survival and other relevant cancer-related outcomes. Results: The search yielded 938 references of which 68 were included for qualitative synthesis. There was limited evidence to support rechallenge with chemotherapy, targeted therapy or both. Compared with placebo, an overall survival benefi t for trifl uridine/tipiracil (also known as TAS-102) or regorafenib has been shown for patients previously treated with conventional chemotherapy and targeted therapy. There was no evidence to suggest a difference in effi cacy between these treatments. Patient choice and quality of life at this stage of treatment should also be considered when choosing an appropriate therapy. Conclusions: These fi ndings support the introduction of an approved agent such as trifl uridine/tipiracil or regorafenib beyond the second line before any rechallenge in patients with mCRC who have failed second line treatment.]

AFFILIATIONS

  1. Instituto CUF de Oncologia, Lisbon, Portugal
  2. Asklepios Tumorzentrum Hamburg, Hamburg, Germany
  3. Medical University Vienna, Department of Medicine I and Comprehensive Cancer Centre Vienna, Vienna, Austria
  4. University Hamburg, Hubertus Wald Tumor Center and Department for Hematology and Oncology, Hamburg, Germany
  5. Servier Global Medical Affairs, Oncology, Suresnes
  6. Georges Pompidou European Hospital, Paris Descartes University, Gastroenterology and Digestive Oncology, Paris, France

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