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Cetuximab versus bevacizumab in metastatic colorectal cancer: a comparative effectiveness study

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Uncertainty exists regarding comparative effectiveness of cetuximab versus bevacizumab in metastatic colorectal cancer (mCRC). We conducted a retrospective head-to-head multi-cohort study comparing clinical outcomes from both antibodies

Methods

Cohorts were defined by treatment line and subgroups by (K)RAS status and tumour sidedness. Among other outcomes, we estimated and compared response rates, progression-free (PFS) and overall survival (OS).

Results

Between January 2010 and April 2018, 311 patients were included. Except for (K)RAS mutation status, baseline characteristics were balanced across treatment groups. In the full analysis of first and second-line cohorts, PFS (first-line: HR = 0.85; 95% CI 0.64 to 1.13; P = 0.26; second-line: HR = 1.16; 95% CI 0.74 to 1.83; P = 0.51) and OS (first-line: HR = 0.83; 95% CI 0.61 to 1.15; P = 0.26; second-line: HR = 0.88; 95% CI 0.56 to 1.38; P = 0.58) were similar between bevacizumab and cetuximab arms. In subgroup analyses of first-line therapy, we found a survival difference favouring bevacizumab in right-sided tumours (PFS: HR = 0.52; 95% CI 0.29 to 0.93; P = 0.025; OS: HR = 0.60; 95% CI 0.32 to 1.12; P = 0.11), but not in left-sided (HR = 1.04; 95% CI 0.75 to 1.46; P = 0.81; OS: HR = 0.94; 95% CI 0.65 to 1.36; P = 0.74), or (K)RAS wild-type tumours (PFS: HR = 0.91; 95% CI 0.60 to 1.40; P = 0.67; OS: HR = 0.79; 95% CI 0.50 to 1.25; P = 0.31). Response rates were similar across treatment groups, except for the subgroup of patients bearing right-sided primaries, where bevacizumab performed substantially better.

Conclusion

This study provides evidence suggesting bevacizumab and cetuximab lead to similar effectiveness outcomes in mCRC, except for right-sided tumours, where cetuximab seemed to show considerably poorer outcomes. Further research is needed to confirm these results.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Faculty of Pharmacy, University of Lisbon, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal

    Rui Pedro Marques & Ana Paula Martins

  2. Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal

    Rui Pedro Marques, Helena Luna Pais & António Quintela

  3. Centre for Health Evaluation & Research (CEFAR), Portuguese Pharmacy Association (ANF), Lisbon, Portugal

    Ana Rita Godinho & Peter Heudtlass

Authors
  1. Rui Pedro Marques
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  2. Ana Rita Godinho
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  3. Peter Heudtlass
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  4. Helena Luna Pais
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  5. António Quintela
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  6. Ana Paula Martins
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Contributions

RPM and APM conceived, designed and planned the study. RPM led the study assessments and data acquisition process. HLP and AQ provided expertise on metastatic colorectal cancer and contributed to data acquisition. RPM led the interpretation and discussion of the results and drafting of the manuscript. PH and ARG performed the statistical analysis, interpreted and discussed the results, and contributed to drafting of the manuscript. All authors read, provided feedback and approved the final manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Rui Pedro Marques.

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All authors affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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Marques, R.P., Godinho, A.R., Heudtlass, P. et al. Cetuximab versus bevacizumab in metastatic colorectal cancer: a comparative effectiveness study. J Cancer Res Clin Oncol 146, 1321–1334 (2020). https://doi.org/10.1007/s00432-020-03167-0

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  • DOI: https://doi.org/10.1007/s00432-020-03167-0

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