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Early tumor shrinkage after first-line medical treatment of metastatic colorectal cancer: a meta-analysis

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Abstract

Background

Early tumor shrinkage (ETS) is a response-related endpoint of clinical trials of chemotherapy (CHT) of patients with metastatic colorectal cancer (mCRC). It identifies a dimensional reduction of tumor size by at least 20–30% after 6–8 weeks of CHT.

Methods

A literature search of randomized trials of systemic treatment including CHT with or without antiangiogenics or anti-EGFR inhibitors in patients with mCRC has been conducted, and studies reporting the results of the relationship of ETS with overall survival (OS) and progression-free survival (PFS) were selected.

Results

Twelve trials, including 3117 patients, have been included; all data were retrospective and only 72% of the enrolled patients have been evaluated for ETS. Two meta-analyses, each including 20 study cohorts from the selected 12 trials, reported a strong relationship of ETS with OS (HR 0.62; CIs 0.55–0.69) and of ETS with PFS (HR 0.66; CIs 0.60–0.73). However, both meta-analyses displayed a high level of heterogeneity. Among nine possible moderators, three variables (median age, surgery of metastases, and publication year) were able to explain at least a part of this heterogeneity.

Conclusion

ETS is a simple and interesting intermediate endpoint for clinical practice and future trials of medical treatments of patients with mCRC, but a large prospective analysis and validation are mandatory.

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Authors and Affiliations

  1. Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, 18038, Sanremo, Imperia, Italy

    Giuseppe A. Colloca, Antonella Venturino & Domenico Guarneri

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  1. Giuseppe A. Colloca
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Correspondence to Giuseppe A. Colloca.

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Colloca, G.A., Venturino, A. & Guarneri, D. Early tumor shrinkage after first-line medical treatment of metastatic colorectal cancer: a meta-analysis. Int J Clin Oncol 24, 231–240 (2019). https://doi.org/10.1007/s10147-019-01405-1

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