Chinese clinical oncology · 2026
Efficacy and safety of TAS-102 followed by regorafenib or reverse sequence in later-line treatment of metastatic colorectal cancer: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Sapapsap Bannawich, Champarhorm Sirapratch, Pongpun Anchana, Kanchana Nattapong, Tantivit Jittipon, Leelakanok Nattawut
Аннотация
BACKGROUND: Trifluridine/tipiracil (TAS-102) and regorafenib are approved and widely utilized as later-line treatment options for patients with metastatic colorectal cancer (mCRC). However, the optimal sequence between these agents remains unclear. We conducted a systematic review and meta-analysis to compare the efficacy and safety of two treatment sequences: TAS-102 followed by regorafenib (TR) versus regorafenib followed by TAS-102 (RT) in patients with mCRC who had previously failed chemotherapy.
METHODS: This study was registered with PROSPERO (CRD42024622437). We systematically searched six databases (PubMed, Scopus, CINAHL, ScienceDirect, medRXiv, and OpenGrey) up to June 1, 2025. Risk of bias was assessed using the ROBINS-I tool. Pooled estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. For studies lacking hazard ratios (HRs), we estimated the HRs using the ratio of median survival times. Publication bias was evaluated with a funnel plot.
RESULTS: Thirteen observational studies with moderate to critical risk of bias were included. No significant difference was found in overall survival (OS) (HR =1.04, 95% CI: 0.86-1.25, I2=72%) or progression-free survival (PFS) (HR =1.34, 95% CI: 0.77-2.34, I2=92%) between the TR and RT groups. The RT group had a higher disease control rate (DCR) (33.1% vs. 28.0%) and tended to have more adverse events (AEs).
CONCLUSIONS: OS and PFS outcomes were comparable between patients treated with TAS-102 followed by regorafenib and those receiving the reverse sequence. Although the RT group was associated with a slightly higher DCR, this was accompanied by a trend toward increased AEs.
METHODS: This study was registered with PROSPERO (CRD42024622437). We systematically searched six databases (PubMed, Scopus, CINAHL, ScienceDirect, medRXiv, and OpenGrey) up to June 1, 2025. Risk of bias was assessed using the ROBINS-I tool. Pooled estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. For studies lacking hazard ratios (HRs), we estimated the HRs using the ratio of median survival times. Publication bias was evaluated with a funnel plot.
RESULTS: Thirteen observational studies with moderate to critical risk of bias were included. No significant difference was found in overall survival (OS) (HR =1.04, 95% CI: 0.86-1.25, I2=72%) or progression-free survival (PFS) (HR =1.34, 95% CI: 0.77-2.34, I2=92%) between the TR and RT groups. The RT group had a higher disease control rate (DCR) (33.1% vs. 28.0%) and tended to have more adverse events (AEs).
CONCLUSIONS: OS and PFS outcomes were comparable between patients treated with TAS-102 followed by regorafenib and those receiving the reverse sequence. Although the RT group was associated with a slightly higher DCR, this was accompanied by a trend toward increased AEs.