Translational cancer research · 2026
The role of targeted therapy in the management of colorectal cancer liver metastases: a systematic review and meta-analysis.
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Yan Ming, Bai Rixing, Yan Wenmao
Аннотация
BACKGROUND: Colorectal cancer liver metastases (CRLM) are a leading cause of mortality in colorectal cancer (CRC) patients. Targeted therapy is widely used, but its precise impact on survival, tumor response, and resectability remains unclear. This study aimed to systematically evaluate the efficacy and safety of targeted therapy in CRLM patients through a meta-analysis.
METHODS: We searched PubMed, Embase, Web of Science, and Cochrane Library up to July 2025. Randomized controlled trials (RCTs) and cohort studies evaluating targeted therapy in CRLM were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary outcomes included objective response rate (ORR), disease control rate (DCR), conversion to resection, and adverse events (AEs). Meta-analyses were performed using random- or fixed-effects models. Risk of bias was assessed with Cochrane RoB 2.0 and Newcastle-Ottawa Scale; evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
RESULTS: Thirty-four studies involving 12,084 patients were included. Targeted therapy significantly improved OS [hazard ratio (HR) =0.82, 95% confidence interval (CI): 0.76-0.89] and PFS (HR =0.74, 95% CI: 0.68-0.80). ORR and DCR were also higher [ORR, risk ratio (RR) =1.36, 95% CI: 1.20-1.54; DCR, RR =1.22, 95% CI: 1.10-1.35]. Conversion to resection increased (RR =1.45, 95% CI: 1.18-1.79), particularly in RAS wild-type, left-sided tumors. Grade ≥3 AEs were more frequent but manageable. Benefits were most pronounced in first-line and biomarker-selected populations.
CONCLUSIONS: Targeted therapy improves survival, tumor response, and resectability in CRLM, especially in biomarker-selected subgroups. These findings support its integration into precision-based multidisciplinary management.
METHODS: We searched PubMed, Embase, Web of Science, and Cochrane Library up to July 2025. Randomized controlled trials (RCTs) and cohort studies evaluating targeted therapy in CRLM were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary outcomes included objective response rate (ORR), disease control rate (DCR), conversion to resection, and adverse events (AEs). Meta-analyses were performed using random- or fixed-effects models. Risk of bias was assessed with Cochrane RoB 2.0 and Newcastle-Ottawa Scale; evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
RESULTS: Thirty-four studies involving 12,084 patients were included. Targeted therapy significantly improved OS [hazard ratio (HR) =0.82, 95% confidence interval (CI): 0.76-0.89] and PFS (HR =0.74, 95% CI: 0.68-0.80). ORR and DCR were also higher [ORR, risk ratio (RR) =1.36, 95% CI: 1.20-1.54; DCR, RR =1.22, 95% CI: 1.10-1.35]. Conversion to resection increased (RR =1.45, 95% CI: 1.18-1.79), particularly in RAS wild-type, left-sided tumors. Grade ≥3 AEs were more frequent but manageable. Benefits were most pronounced in first-line and biomarker-selected populations.
CONCLUSIONS: Targeted therapy improves survival, tumor response, and resectability in CRLM, especially in biomarker-selected subgroups. These findings support its integration into precision-based multidisciplinary management.