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Bevacizumab and erlotinib versus bevacizumab for colorectal cancer treatment: systematic review and meta-analysis

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Abstract

Background Improving the survival of patients diagnosed with metastatic colorectal cancer requires the use of chemotherapy to be managed with minimum adverse effects. Randomized control trials (RCTs) have shown promising results with a combination of bevacizumab and erlotinib to block two important tumor growth pathways, namely vascular endothelial growth factor and epidermal growth factor receptor. Aim of the Review We aimed to examine the efficacy and safety of the combination of bevacizumab and erlotinib with bevacizumab alone in the maintenance treatment of metastatic colorectal cancer, by examining PFS, OS, overall response rate (ORR), and toxicity. This study performed a systematic review meta-analysis using existing randomized clinical trial. Methods Randomized controlled trials were systematically reviewed from PubMed, Cochrane library, SCOPUS, CRD, and Google scholar databases. After evaluating the quality of studies through the Cochrane checklist, data of the relevant studies were extracted. This meta-analysis included outcomes of overall survival, progression-free survival of the disease through the hazard ratio, and the upper and lower confidence intervals for the third and fourth degree side effects of relative risk. To perform the meta-analysis for both types of survival, two fixed and random effect models were used. Results A total of three trials, providing data of 682 patients who received maintenance treatment, were included in this meta-analysis. Conclusion The combination of bevacizumab and erlotinib significantly increased the overall survival compared to using bevacizumab alone [HR = 0.78, 95% CI 0.66–0.93]. This combination, effectively increased progression-free survival [HR = 0.81, 95% CI 0.7–0.93] too. The side effects of diarrhea and grade III rash were more frequent in the group administered bevacizumab plus erlotinib. The combination of bevacizumab and erlotinib, in the maintenance treatment of metastatic colorectal cancer, significantly improved the overall survival and progression-free survival of patients, and the resulting side effects were easily treatable.

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Acknowledgments

The authors would like to thank Dr. Malek Zarei for his facilitative and collaborative efforts to this research.

Funding

This article is part of the dissertation entitled “Health technology assessment of bevacizumab compare with combination of bevacizumab with erlotinib for treatment of patients with metastatic colorectal cancer” for the Master’s Degree in Health Technology Assessment, supported by the Iran University of Medical Sciences (code: iums/shmis-1395/9311592005).

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Authors and Affiliations

  1. School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran

    Sara Kaveh

  2. Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

    Parvin Ebrahimi

  3. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

    Aziz Rezapour

  4. Naft Hospital, Shiraz, Iran

    Masoud Mozafari

  5. Prevention Center of Social-Mental Injuries, Ilam University of Medical Sciences, Ilam, Iran

    Kourosh Sayehmiri

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  1. Sara Kaveh
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Correspondence to Kourosh Sayehmiri.

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Kaveh, S., Ebrahimi, P., Rezapour, A. et al. Bevacizumab and erlotinib versus bevacizumab for colorectal cancer treatment: systematic review and meta-analysis. Int J Clin Pharm 41, 30–41 (2019). https://doi.org/10.1007/s11096-018-0754-1

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