Conversion strategies in RAS wild-type colorectal liver metastases: a systematic review and meta-analysis of first-line trials comparing regimens with anti-epidermal growth factor receptor inhibitors versus bevacizumab.
Salvatore Corallo, Ottavia Cicerone, Cecilia Brigati et al.
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In 30 seconds
This systematic review and meta-analysis compared first-line chemotherapy combined with an EGFR inhibitor or bevacizumab in patients with RAS wild-type metastatic colorectal cancer and liver-limited disease, focusing on initially unresectable colorectal liver metastases. Six randomised controlled trials contributed data from 795 patients. There was no statistically significant difference between regimens in progression-free or overall survival, or in complete (R0) resection rates. EGFR inhibitor regimens improved response rate and depth of response, with pooled odds ratios of 1.98 and 1.70, respectively. Analyses by primary tumour location found no significant survival advantage for either treatment.
Key findings
- Across six trials and 795 patients, neither regimen showed a statistically significant advantage in progression-free or overall survival.
- EGFR inhibitor regimens improved response rate (pooled OR 1.98) and depth of response (pooled OR 1.70).
- Complete (R0) resection rates did not differ significantly between treatment strategies.
- Primary tumour location subgroup analyses found no significant survival advantage for either agent in left- or right-sided disease.
Why it matters
For conversion therapy, greater tumour shrinkage does not necessarily translate into more complete resections or longer survival. These pooled findings help frame the choice between EGFR inhibitor- and bevacizumab-based regimens: response outcomes favoured EGFR inhibition, but the review found no corresponding advantage in the outcomes most directly tied to durable disease control.
What to keep in mind
The evidence is based on six trials, and fewer studies contributed to response, resection, and depth-of-response analyses. The abstract does not report pooled effect estimates for survival or R0 resection.