Efficacy and safety of EGFR and VEGF inhibitors in stage II-IV colon cancer: A retrospective analysis using the TriNetX database.

Abstract

e15656 Background: The use of targeted therapies, including EGFR and VEGF inhibitors, in combination with chemotherapy has revolutionized the treatment of advanced colon cancer. This study aimed to assess the efficacy and safety of these targeted therapies in stage II-IV colon cancer patients compared to chemotherapy alone. Methods: This retrospective study utilized the TriNetX database (January 2017–December 2022) to evaluate patients diagnosed with stage II-IV colon cancer. Patients were categorized into two cohorts: those receiving a combination of targeted therapy with chemotherapy (e.g., EGFR or VEGF inhibitors alongside chemotherapy) and those treated with chemotherapy alone (5-FU or capecitabine). Propensity score matching (1:1) was applied to balance the cohorts based on baseline characteristics, including age, sex, race, cancer stage, and comorbidities. Results: After matching, each cohort was reduced to 1,795 patients, achieving balance in demographics such as age (mean 65.4 ± 12.4 vs. 65.7 ± 12.7 years), sex (51.69% male vs. 50.86% male), ethnicity (39.61% vs. 37.88% not Hispanic or Latino), and White race (47.46% vs. 45.57%). The median follow-up was shorter in the targeted therapy with chemotherapy group (646 days; IQR: 744 days) compared to the chemotherapy-only group (930 days; IQR: 700 days). Median overall survival (OS) was significantly shorter in the targeted therapy with chemotherapy group (780 days) compared to the chemotherapy-only group, with survival probabilities at the end of the time window of 38.52% and 66.80%, respectively. The hazard ratio (HR) for survival was 2.077 (95% CI: 1.867–2.312, p < 0.0001), indicating a significantly higher risk of mortality in the targeted therapy with chemotherapy group compared to the chemotherapy-only group. The risk of Major Adverse Cardiovascular Events (MACE) was similar between the targeted therapy with chemotherapy group and the chemotherapy-only group (HR: 1.03, 95% CI: 0.885–1.199, p = 0.8197). The risk of Major Adverse Kidney Events (MAKEs) was higher in the targeted therapy with chemotherapy group compared to the chemotherapy-only group (HR: 1.325, 95% CI: 1.142–1.538, p < 0.0001). The risk of gastrointestinal (GI) bleeding was also higher in the targeted therapy with chemotherapy group compared to the chemotherapy-only group (HR: 1.185, 95% CI: 0.91–1.56, p = 0.0011). Conclusions: Targeted therapies with EGFR or VEGF inhibitors improve survival in advanced colon cancer but are associated with increased risks of kidney-related adverse events and GI bleeding. Clinicians should balance benefits and risks and monitor for complications. Further research is needed to refine patient selection and management.