Comparative efficacy and adverse reactions of apatinib-chemotherapy combinations versus chemotherapy alone for treatment of advanced colorectal cancer: a meta-analysis of randomized controlled trials.

OBJECTIVE: Apatinib mesylate is the first small-molecule anti-angiogenic agent that has been shown to be effective and well-tolerated for treatment of advanced gastric cancer, and has shown encouraging efficacy for treatment of advanced colorectal cancer (CRC). However, previous studies reported diverse efficacy and safety results of apatinib for treatment of advanced CRC. This meta-analysis aimed to compare the efficacy and safety of apatinib plus chemotherapy (trial group) versus chemotherapy alone (control group) for treatment of advanced CRC. METHODS: A joint search was performed in electronic databases to retrieve randomized clinical trials (RCTs) reporting the efficacy and adverse reactions of apatinib in the treatment of advanced CRC. The pooled survival, treatment responses, and safety were estimated and compared between the trial and control groups. RESULTS: A total of 7 eligible RCTs involving 539 colorectal cancer patients were enrolled. Meta-analysis showed significantly higher overall response rate (risk ratio (RR) = 1.46, P < 0.00001), disease control rate (RR = 1.24, P < 0.00001), complete response (RR = 1.72, P = 0.01), PR (RR = 1.43, P = 0.001), overall survival (mean difference (MD) = 3.89, P = 0.0006), and progression-free survival (MD = 2.94, P < 0.00001) and lower progressive disease (RR = 0.37, P < 0.00001) in the trial group than in the control group; however, there were no significant differences between the two groups in terms of stable disease (RR = 0.89, P = 0.38) or incidence of adverse reactions (RR = 1.01, P = 0.92). CONCLUSION: Apatinib plus chemotherapy shows a higher efficacy and comparable safety for treatment of advanced CRC in relative to chemotherapy alone.