Early tumor shrinkage after first-line medical treatment of metastatic colorectal cancer: a meta-analysis

  • Giuseppe A. CollocaEmail author
  • Antonella Venturino
  • Domenico Guarneri
Review Article



Early tumor shrinkage (ETS) is a response-related endpoint of clinical trials of chemotherapy (CHT) of patients with metastatic colorectal cancer (mCRC). It identifies a dimensional reduction of tumor size by at least 20–30% after 6–8 weeks of CHT.


A literature search of randomized trials of systemic treatment including CHT with or without antiangiogenics or anti-EGFR inhibitors in patients with mCRC has been conducted, and studies reporting the results of the relationship of ETS with overall survival (OS) and progression-free survival (PFS) were selected.


Twelve trials, including 3117 patients, have been included; all data were retrospective and only 72% of the enrolled patients have been evaluated for ETS. Two meta-analyses, each including 20 study cohorts from the selected 12 trials, reported a strong relationship of ETS with OS (HR 0.62; CIs 0.55–0.69) and of ETS with PFS (HR 0.66; CIs 0.60–0.73). However, both meta-analyses displayed a high level of heterogeneity. Among nine possible moderators, three variables (median age, surgery of metastases, and publication year) were able to explain at least a part of this heterogeneity.


ETS is a simple and interesting intermediate endpoint for clinical practice and future trials of medical treatments of patients with mCRC, but a large prospective analysis and validation are mandatory.


Early tumor shrinkage Chemotherapy Endpoint Prognosis Bevacizumab Cetuximab 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Giuseppe A. Colloca
    • 1
    Email author
  • Antonella Venturino
    • 1
  • Domenico Guarneri
    • 1
  1. 1.Department of OncologyOspedale Civile di SanremoSanremoItaly

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