| Background: Chemotherapy and targeted drugs improved survival of patients suffering from metastatic colorectal cancer(mCRC).As for the intensive first-line therapy of mCRC,there are sixteen regimens using chemotherapy alone or combined with targeted drugs were recommended by the NCCN(version 18.2),but which intensive systematic therapy should be preferred is still matter of controversy.Consequently,we conduct a bayesian network meta-analysis to compare and rank the short-term and long-term efficacy of first-line regimens for mCRC.Methods: The Pubmed,Embase and Cochrane Central Register of Controlled Trails were comprehensively searched for eligible randomized controlled trails(RCTs) to evaluate the long term and short term efficacies of regimens for the first-line treatment of patients with mCRC from inception to the end of May 31,2018.OpenBUGS and STATA were utilized to conduct the bayesian network meta-analysis.We estimated HRs for overall survival(OS) and progression-free survival(PFS),while ORsfor objective response rate(ORR) and disease-control rate(DCR).Otherwise,surface under the cumulative ranking curve(SUCRA) was using to evaluate the rank possibility of each regimen.Results: 36 RCTs comprising 13625 individuals with mCRC were included.The results revealed that FOLFOXIRI plus bevacizumab prolonger the OS and PFS and improved ORR and DCR than other regimens.There were no significant differences between XEL and FULV in terms of OS,PFS,ORR and DCR.Regimens of chemotherapy plus targeted drug rank higher than most of the chemotherapy-alone regimens.Interestingly,FOLFOXIRI had a better ranking than some chemotherapy plus targeted drugs.Conclusion: Our analysis definitively stated that FOLFOXIRI plus bevacizumab when administered as intensive first-line treatment for patients with mCRC showed the best performance for efficacy.We have preference for FOLFOXIRI,if only chemotherapy-alone regimens were available. |
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