The effectiveness and safety of bevacizumab versus cetuximab in the treatment of colorectal cancer: a systematic review and meta-analysis

Background Despite available meta-analyses, comparative efficacy and safety between bevacizumab and cetuximab-containing therapies in treating advanced colorectal cancer (CRC) still need to be elucidated. Aim This meta-analysis aimed to investigate the efficacy and grade 3-5 treatment-related adverse events (TARE3-5) of bevacizumab versus cetuximab in treating advanced CRC. Method A random sample of 400 patients aged 65 years or older from a clinical trial in four Swedish hospitals was selected. All patients' emergency department visits within 12 months after discharge were assessed with AT-HARM10. The main outcome measures were the percentage of successfully assessed visits for applicability and the interrater reliability (Cohen's kappa). Results Five RCTs and four observational cohort studies (2970 patients) were included. The bevacizumab-containing group was associated with a significantly lower ORR (risk ratio RR 0.91, 95% confidence interval CI 0.85-0.97, P = 0.006) than the cetuximab group. Bevacizumab was associated with significant superior DCR (RR 1.05, 95% CI 1.01 to 1.10, P = 0.02) and prolonged OS (hazard ratio HR 0.81, 95% CI 0.74-0.90, P < 0.0001) than cetuximab. No significant differences were observed for PFS (HR 0.97, 95% CI 0.92-1.03, P = 0.33) between the groups. Bevacizumab showed a lower rate of skin disorders (RR 0.10, 95% CI 0.02-0.43, P = 0.002) than cetuximab. There were no significant differences between the groups in the overall rate of TRAE3-5 (RR 0.92, 95% CI 0.84-1.01, P = 0.08). Subgroup analysis found a lower TARE3-5 rate in the bevacizumab group in RCTs (RR 0.91, 95% CI 0.83-1.00, P = 0.04). Conclusion Bevacizumab could increase DCR, prolong OS, and lower the skin disorder rate to treat patients with advanced CRC.