Tolerability on Serious Adverse Events of First-Line Bevacizumab and Cetuximab for RAS Wild-Type Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis
- 주제(키워드) adverse events , bevacizumab , cetuximab , metastatic colorectal cancer , medication safety
- 주제(기타) Health Care Sciences & Services
- 주제(기타) Health Policy & Services
- 설명문(일반) [Han, Yu Na; Rhie, Sandy Jeong] Ewha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul 03760, South Korea; [Choi, Yeo Jin] CHA Univ, Grad Sch Clin Pharm, Seongnam 13488, South Korea; [Rhie, Sandy Jeong] Ewha Womans Univ, Grad Sch Pharmaceut Sci, Coll Pharm, Seoul 03760, South Korea
- 등재 SCIE, SSCI, SCOPUS
- OA유형 gold, Green Published
- 발행기관 MDPI
- 발행년도 2022
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000190447
- 본문언어 영어
- Published As https://doi.org/10.3390/healthcare10020217
- PubMed https://pubmed.ncbi.nlm.nih.gov/35206832
초록/요약
Proper medication management is crucial in metastatic colorectal cancer because of its substantially low survival rate. There has been advancing evidence on the efficacy of the two most prescribed targeted agents (bevacizumab and cetuximab); however, comprehensive analyses on their safety are limited. This study aims to comprehensively assess the clinical safety of first-line bevacizumab and cetuximab-based chemotherapy in unresectable RAS wild-type metastatic colorectal cancer patients and to provide guidance on the selection of appropriate targeted therapeutic agents. Keyword searches of MEDLINE, Cochrane Library, and ClinicalKey were conducted per PRISMA guidelines. We performed pooled analysis on safety outcomes from six studies which administered FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (5-fluorouracil, leucovorin, irinotecan) as backbone chemotherapy. Thirty different adverse events from six categories were compared. First-line bevacizumab-based chemotherapy substantially lowered the risks of adverse events related to the dermatological (RR 0.24, 95% CI: 0.11-0.53, p < 0.00001) and renal systems (RR 0.57, 95% CI: 0.37-0.86, p = 0.007), while significantly increasing the incidence of cardiovascular adverse events (RR 4.65, 95% CI: 1.83-11.78, p = 0.001). Thus, first-line cetuximab-based chemotherapy increases patient susceptibility to dermatological and renal adverse events, especially with rash and electrolyte disorders, whereas bevacizumab-based chemotherapy increases cardiovascular risks such as hypertension and arrhythmia.
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