Integrated Evaluation of Survival, Surgical Conversion, and Toxicity for Induction Therapy in Initially Unresectable Colorectal Liver Metastases: An Individual Patient Data Network Meta-analysis
In brief
Bevacizumab-triplet chemo nearly guarantees higher resection and longer PFS
In a pooled analysis of seven trials (1368 patients), adding bevacizumab to a triplet chemotherapy regimen gave the highest chance of converting unresectable colorectal liver metastases to resectable disease and extended progression-free survival, though overall survival was unchanged and severe side effects were more common. A bevacizumab-doublet regimen offered a more balanced benefit-risk profile and may be the preferred option for many patients.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 16 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Guilin Nie, Xinming Li, Yaoqun Wang, Jianrong Xu, Ningyuan Wen, Bei Li, et al.
- PMID
- 42463606
- DOI
- 10.1245/s10434-026-20188-0
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (top studies of the week, 19 July 2026): IPD network meta‑analysis of induction therapy for CRLM
- Picked for Surgery (top studies of the week, 19 July 2026).
Abstract
BACKGROUND: Patients with initially unresectable colorectal cancer liver metastases (CRLM) could derive benefits from active induction regimens by increasing the likelihood of surgical conversion. However, the comparative benefit-risk profiles of currently available regimens remain unclear. We performed an individual patient data (IPD) and network meta-analysis (NMA) to compare the efficacy of active induction regimens. PATIENTS AND METHODS: IPD was reconstructed from randomized controlled trials (RCTs). The primary outcome was progression-free survival (PFS). Secondary outcomes included R0-1 resection rate, overall survival (OS), and grade ≥ 3 adverse events (AEs). Subgroup analyses were conducted according to KRAS/BRAF status and primary tumor sidedness. An entropy-weighted TOPSIS model was used to integrate efficacy and safety outcomes. RESULTS: Seven RCTs involving 1368 patients were included. IPD-based network analysis suggested that bevacizumab + triplet-chemotherapy was associated with the highest probability of improving R0-1 resection rate (0.99) and prolonging PFS (0.99). No significant differences in OS were observed among targeted therapy-based regimens. For patients with KRAS/BRAF wild-type tumors, cetuximab + doublet-chemotherapy is the only therapy performed better than chemotherapy in prolonging PFS. Bevacizumab + triplet-chemotherapy demonstrated superior efficacy among patients with KRAS/BRAF-mutant tumors. No significant PFS differences were observed among therapies in both left-sided and right-sided. Bevacizumab + doublet-chemotherapy demonstrated a more balanced benefit-risk profile with the highest Topsis scores (0.67). CONCLUSIONS: Bevacizumab plus triplet chemotherapy improves disease control and surgical conversion benefits but is associated with greater toxicity. Bevacizumab plus doublet chemotherapy showed the most favorable benefit-risk balance and may represent an optimal compromise for patients with initially unresectable CRLM.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.