The first-line treatment choice of EGFRIs plus doublet chemotherapy vs. bevacizumab plus doublet chemotherapy remains a topic of interest for patients with left-sided RAS WT mCRC. We conducted a systematic literature review and meta-analysis of clinical trial data published between 2015 and 2024. We evaluated the relative efficacy and safety of first-line EGFRIs plus doublet chemotherapy (FOLFIRI or FOLFOX) vs. bevacizumab plus doublet chemotherapy for patients with RAS WT left-sided mCRC, as well as in all- and right-sided tumors. We identified eight trials with 2624 patients. Five trials reported outcomes by tumor sidedness. In the left-sided population, overall survival (OS) (Hazard Ratio (HR) = 0.80, 95% Confidence Interval (CI): 0.71-0.90) and objective response rate (ORR) (Odds ratio [OR]=1.61, 95% CI: 1.30-1.99) favored EGFRI plus chemotherapy, while no statistically significant differences were observed for progression-free survival (PFS) (HR=0.93, 95% CI: 0.84-1.04) or resection rate (RR). Similar results were found in the all-sided population. In the right-sided population, PFS favored bevacizumab plus chemotherapy (HR=1.45, 95% CI: 1.19-1.78), while no statistically significant differences were observed for OS (HR=1.17, 95% CI: 0.95-1.44), ORR (OR=0.99, 95% CI: 0.69-1.41), and RR. Early tumor shrinkage in the all-sided population favored EGFRI plus chemotherapy (OR=1.72; 95% CI: 1.36-2.17); limited data precluded evaluation by sidedness. Safety was available in 6 trials for all-sided tumors and 1 trial for left-sided tumors, each demonstrating typical class-specific adverse events. This most comprehensive meta-analysis indicates a benefit for first-line EGFRI plus chemotherapy over bevacizumab plus chemotherapy in patients with left-sided RAS WT mCRC., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: N. Hooda, M. Suh, H. Reichert, and J. Fryzek are employees of EpidStrategies, A Division of ToxStrategies, LLC. and received a grant from Amgen for this research. N. Hooda has also received research funding from Sanofi, and SpringWorks Therapeutics. M. Rehn, V. Chia, D. Younan, K. Mezzi are employees of Amgen and may hold shares and/or stock options in the company. J. Soeda is an employee of Takeda and may hold shares/and or stock options in the company. F. Rivera has served on advisory boards for Amgen, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Celgene, Lilly, Merck Serono, MSD, Roche, Sanofi-Aventis, and Servier. He has received research funding from Amgen, Bayer, Celgene, Lilly, Merck Serono, MSD, Roche, Sanofi-Aventis, and Servier. He has received honoraria for talks/presentations from Amgen, Bayer, Bristol Myers Squibb, Celgene, Lilly, Merck Serono, MSD, Roche, Sanofi-Aventis, and Servier. He has received grant support from Amgen, Bristol Myers Squibb, and MSD. K. Muro has received grants from Amgen, Chugai, Sanofi, Astellas, Eisai, Novartis, Pfizer, MSD, ONO Pharmaceutical, Daiichi Sankyo, Taiho. He has received personal fees from Amgen, MSD, ONO Pharmaceutical, Daiichi Sankyo, Taiho, Takeda, Bristol-Myers Squibb, Eli Lilly, and AstraZeneca, outside the submitted work. K. Shitara has received personal fees for consulting and advisory roles from Bristol Myers Squibb, Takeda, Ono Pharmaceutical, Novartis, Daiichi Sankyo, Amgen, Boehringer Ingelheim, Merck Pharmaceutical, Astellas, Guardant Health Japan, Janssen, AstraZeneca, Zymeworks Biopharmaceuticals, ALX Oncology Inc., and Bayer. He has received honoraria from Bristol-Myers Squibb, Ono Pharmaceutical, Janssen, Eli Lilly, Astellas, and AstraZeneca. He has also received research funding (all to institution) from Astellas, Ono Pharmaceutical, Daiichi Sankyo, Taiho Pharmaceutical, Chugai, Merck Pharmaceutical, Amgen, Eisai, PRA Health Sciences and Syneos Health, outside the submitted work. M. Peeters has served on advisory boards for Amgen, Bayer, Bimini, Ipsen, Merck, MSD, Qurin, Remedus, Sanofi, Sirtex, and Terumo. He has received speaker fees from Amgen, Bayer, Bristol-Myers Squibb, Merck, MSD, Roche, Sanofi, Servier, and Sirtex. He reports scientific grants from Amgen (inst.), Bayer (inst.), Bristol-Myers Squibb (inst.), Ipsen (inst.), Novartis (inst.), and Roche (inst.). S. Stintzing is an employee of Charité – Universitaetsmedizin Berlin. He has served on advisory boards for Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, ESAI, Lilly, Merck KgaA, MSD, Pierre-Fabre, Roche, Sanofi, Servier, Taiho, and Takeda. He has received honoraria for talks/presentations and advisory board participation from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, ESAI, Leo-Pharma, Lilly, Merck KgaA, MSD, Pierre-Fabre, Roche, Sanofi, Servier, Taiho, and Takeda. He has received research funding from Merck KgaA, Pierre-Fabre, Roche, and Servier. He has educational collaborationS with Medscape Foundation and COR2ED. He is a member of ASCO, ESMO, DKG, AIO, and DHGO. T. Yoshino has received honoraria from Chugai Pharma, Takeda Pharma, Merck, Bayer Yakuhin, Ono Pharmaceutical, and MSD K.K. He has received consulting fees from Sumitomo Corp. and research grants from Amgen, Chugai, Daiichi Sankyo, Eisai, FALCO Biosystems, Genomedia Inc., Molecular Health, MSD, Nippon Boehringer Ingelheim, Ono, Pfizer, Roche Diagnostics, Sanofi, Sysmex, and Taiho. V. Heinemann has received honoraria Amgen, Merck, Roche, Sanofi, SIRTEX, Servier, Pfizer, Pierre-Fabre, Astra-Zeneca, MSD, GSK, and Seagen. He participated in consulting and advisory boards for Merck, Amgen, Roche, Sanofi, SIRTEX, Bristol-Myers Squibb, MSD, Novartis, Boehringer Ingelheim, Servier, Pierre-Fabre, Celgene, Terumo, GSK, Oncosil, Nordic, and Seagen. He reports research funding (institution) from Merck, Amgen, Roche, Sanofi, Pfizer, Boehringer-Ingelheim, Sirtex, Bayer, and Servier. He has received travel support from Merck Roche, Amgen, SIRTEX, Bayer, Servier, MSD, and GSK. All remaining authors have declared no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)