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Overall and KRAS-specific results of combined cetuximab treatment and chemotherapy for metastatic colorectal cancer: a meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study compared the efficacy and toxicities of cetuximab combined with chemotherapy versus chemotherapy for patients with metastatic colorectal cancer (mCRC). The influence of KRAS mutation status on the outcomes was also investigated.

Methods

Literature retrieval, trials selection and assessment, data collection, and statistical analysis were performed according to the Cochrane Handbook 5.0.2. The outcome measures were tumor response rate, progression-free survival, overall survival, and adverse effects.

Results

Four randomized controlled trials, comprising totally 2,912 patients, were included. Meta-analysis showed higher response rate (RR 1.93; 95% CI, 1.14–3.26) and significant improvement in progression-free survival (PFS; HR 0.80; 95% CI, 0.67–0.95) in cetuximab-chemotherapy groups versus chemotherapy groups. There was no significant difference between the two treatment groups regarding overall survival (OS; HR 0.95; 95% CI, 0.87–1.05). In wild-type KRAS patients, treatment with cetuximab plus chemotherapy significantly increased response rate (RR 1.44; 95% CI, 1.20–1.73) and improved PFS (HR 0.64; 95% CI, 0.50–0.84), as compared with chemotherapy groups, but not for OS (HR 0.84; 95% CI, 0.64–1.11). In mutant KRAS patients, there was no significant difference between those treated with cetuximab plus chemotherapy and those with chemotherapy alone regarding response rate (RR 0.81; 95% CI, 0.61–1.08), PFS (HR 1.37; 95% CI, 0.81–2.31), and OS (HR 1.03; 95% CI, 0.74–1.44). The risk of grade 3/4 rash, diarrhea, neutropenia, and fatigue was significantly increased in cetuximab combination groups as compared with chemotherapy groups.

Conclusions

The use of cetuximab in addition to chemotherapy was a valid alternative for patients with mCRC. Benefit of cetuximab was only limited to patients with wild-type KRAS tumors.

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Authors and Affiliations

  1. Department of Oncology, Tianjin Medical University General Hospital, #154 Anshan Road, Heping District, Tianjin, 300052, China

    Linlin Zhang & Li Ma

  2. Tianjin Lung Cancer Center and Institute, Tianjin Medical University General Hospital, #154 Anshan Road, Heping District, Tianjin, China

    Qinghua Zhou

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  1. Linlin Zhang
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  2. Li Ma
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  3. Qinghua Zhou
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Correspondence to Linlin Zhang or Qinghua Zhou.

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Zhang, L., Ma, L. & Zhou, Q. Overall and KRAS-specific results of combined cetuximab treatment and chemotherapy for metastatic colorectal cancer: a meta-analysis. Int J Colorectal Dis 26, 1025–1033 (2011). https://doi.org/10.1007/s00384-011-1197-5

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