Publication: Optimización de la secuencia de tratamiento en cáncer colorrectal avanzado: meta-análisis y análisis coste-efectividad de la secuencia de empleo de terapias antidiana en cáncer colorrectal avanzado no resecable, ras nativo
Loading...
Files
Official URL
Full text at PDC
Publication Date
2017-02-08
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
En la actualidad existen diferentes alternativas de tratamiento disponibles para el manejo del cáncer colorrectal metastásico (CCRm) no resecable. Tanto la adición de bevacizumab como la de inhibidores de EGFR (iEGFR) a la quimioterapia convencional han demostrado mejorar la supervivencia de los pacientes, y su uso está aprobado para el tratamiento de esta enfermedad. Hasta la fecha dos ensayos clínicos fase III han evaluado estas combinaciones frente a frente en el tratamiento de primera línea del CCRm, RAS no mutado, obteniendo resultados dispares. Estos datos mantienen la incertidumbre sobre la combinación más efectiva y la secuencia óptima de tratamiento para estos pacientes. Ante esta situación, otros factores como el perfil de toxicidad de los fármacos o el coste-efectividad de los mismos, pueden resultar cruciales a la hora de tomar decisiones en la práctica clínica habitual. Con el objetivo de mejorar el conocimiento del tratamiento más efectivo en primera línea para el CCRm, se llevó a cabo un meta-análisis en red evaluando mediante comparaciones directas e indirectas todos los estudios disponibles que analizaran la adición de bevacizumab o iEGFR a quimioterapia versus quimioterapia sola, o el uso de bevacizumab versus iEGFR, ambos en combinación con quimioterapia. Así mismo, para conocer cuál es la estrategia de tratamiento más eficiente en este escenario, se ha realizado un estudio coste-efectividad evaluando tres posibles estrategias de tratamiento en función del uso de estos fármacos en primeras o sucesivas de líneas de tratamiento...
Currently, there are different regimens available for the treatment of unresectable metastatic colorectal cancer (mCRC). Both bevacizumab and EGFR inhibitors (iEGFR) in combination with chemotherapy have showed improvements in progression-free survival (PFS) and overall survival (OS) and their use is widely accepted in this setting. To date, two phase III randomized trials have evaluated these combinations head to head as first line treatment for RAS wild type mCRC finding diverging results. Therefore, the most effective and optimal sequence of treatment of these patients remains unclear. In this setting, other factors such as the toxicity profile of these drugs or their cost-effectiveness maybe key for decision-making in our daily practice. Aiming to have a better knowledge on the most effective regimen for the first line treatment of mCRC, a systematic review of the literature and network meta-analysis combining direct and indirect comparisons was carried out. All the available randomized trials evaluating the use of bevacizumab or EGFRi in combination with chemotherapy versus chemotherapy alone and their head to head comparisons, were analyzed. Moreover, a cost-effective analysis to investigate the most efficient strategy for the treatment of mCRC was performed...
Currently, there are different regimens available for the treatment of unresectable metastatic colorectal cancer (mCRC). Both bevacizumab and EGFR inhibitors (iEGFR) in combination with chemotherapy have showed improvements in progression-free survival (PFS) and overall survival (OS) and their use is widely accepted in this setting. To date, two phase III randomized trials have evaluated these combinations head to head as first line treatment for RAS wild type mCRC finding diverging results. Therefore, the most effective and optimal sequence of treatment of these patients remains unclear. In this setting, other factors such as the toxicity profile of these drugs or their cost-effectiveness maybe key for decision-making in our daily practice. Aiming to have a better knowledge on the most effective regimen for the first line treatment of mCRC, a systematic review of the literature and network meta-analysis combining direct and indirect comparisons was carried out. All the available randomized trials evaluating the use of bevacizumab or EGFRi in combination with chemotherapy versus chemotherapy alone and their head to head comparisons, were analyzed. Moreover, a cost-effective analysis to investigate the most efficient strategy for the treatment of mCRC was performed...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 09-02-2016