The cetuximab group included 1185 patients, and 758 (63

The cetuximab group included 1185 patients, and 758 (63.97%) were male. wild-type mCRC, aimed to compare cetuximab plus FOLFIRI or bevacizumab plus FOLFIRI and reported a significantly longer median OS in the cetuximab group BI-4464 (HR 0.77, 95% confidence interval (CI) 0.62C0.96; and wild-type mCRC. We, therefore, performed a systematic review and meta-analysis to determine the relative efficacy, including long-term survival outcomes and response rates, of first-line treatment with cetuximab versus bevacizumab. Methods Data sources and searches The preferred reporting items for PRISMA guidelines [14] were followed in this systematic review. In March 2018, an electronic search of the following biomedical databases was performed: PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov and Web of Knowledge Conference Proceedings Citation IndexScience (CPCI-S). Abstracts and presentations published by the American Society of Clinical Oncology (ASCO; www.asco.org) and the European Society for Medical Oncology (ESMO; www.esmo.org) were also reviewed. The following search terms were used: metastatic colorectal cancer, targeted agent or targeted therapy, epidermal growth factor receptor inhibitor or EGFR inhibitor or cetuximab, vascular endothelial growth factor inhibitor or VEGF inhibitor or bevacizumab and first line. Study selection criteria Eligible studies were required to meet the following inclusion criteria: RCTs, prospective or observational cohort studies (OCSs) that evaluated the efficacy and safety of first-line cetuximab versus bevacizumab for and and wild-type mCRC (Fig.?1). Open in a separate window Fig. 1 PRISMA 2009 flow diagram Study characteristics The five selected trials were published from Sep 2014 through to Oct 2016 and included patients who received targeted therapies from Apr 2005 through to Dec 2013. Background chemotherapy comprised mFOLFOXIRI [modified irinotecan, oxaliplatin (OXA), 5-fluorouracil (5-FU) and folinate (FOLFOXIRI)], mFOLFOX6 [modified 5-FU, leucovorin (LV) and OXA], FOLFIRI (5-FU, folinate and irinotecan), FOLFOX (5-FU, OXA and LV) or XELOX (capecitabine plus OXA). Overall, these trials analyzed a total 2576 patients receiving targeted therapy. BI-4464 The cetuximab group included 1185 patients, and 758 (63.97%) were male. The bevacizumab group included 1391 patients, and 867 (62.33%) were male. The study quality was rated as high for five studies (Table?1). The baseline characteristics of the five trials are listed in Tables?1 and ?and22. Table 1 Characteristics of Included Studies Randomized Clinical Trial, observational cohort study, progression-free rate, Progression free survival, objective response rate, overall survival, isease control rate Table 2 Characteristics of Included Studies total number, Synchronous Metastases, cetuximab, bevacizumab, Right, left, rectum, Transverse, Multiple, unknown, colon Primary outcomes Five studies reported the median OS and PFS (Table?3). For the cetuximab group, the median OS ranged from 28.3 to 37.8?months, whereas the bevacizumab group displayed BI-4464 a median OS ranging between 25 and 31.04?months. The median OS was better in the cetuximab group than the bevacizumab group [HR 0.89, 95% CI (0.81C0.98); Confidence Cdh5 interval; Risk ratio; GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate Secondary outcomes The ORR was reported in four studies [5, 6, 24, 25]. The.