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Efficacy and safety of anti‐EGFR monoclonal antibodies combined with different chemotherapy regimens in patients with RAS wild‐type metastatic colorectal cancer: A meta‐analysis
Author(s) -
Sun Huan,
Li Yonghong,
Su Yana,
Wu Xinyu,
Zhou Xiaoqin,
Han Jin,
Li Jing
Publication year - 2019
Publication title -
journal of evidence‐based medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.885
H-Index - 22
ISSN - 1756-5391
DOI - 10.1111/jebm.12360
Subject(s) - medicine , irinotecan , hazard ratio , oxaliplatin , oncology , regimen , colorectal cancer , chemotherapy , cetuximab , progression free survival , confidence interval , combination chemotherapy , cancer
Objectives To investigate the efficacy and safety of adding anti‐epidermal growth factor receptor [EGFR] MoAbs to various chemotherapy regimens in patients with RAS wild‐type metastasized colorectal cancer (RAS WT metastatic colorectal cancer [mCRC]) and to identify the optimal combination regimens. Methods We searched MEDLINE, EMBASE, and CENTRAL from the inception date to 20th May 2019. Randomized clinical trials investigating chemotherapy with or without anti‐EGFR MoAbs in treatment of patients with RAS WT mCRC were included. Results Eighteen studies involving 8848 participants were eligible. Comparing with oxaliplatin‐based chemotherapy, adding anti‐EGFR MoAbs benefited only in progression‐free survival (PFS) (hazard ratio [HR] = 0.80, 95% confidence interval [CI]: 0.67 to 0.94), but not in overall survival (OS) (HR = 0.89, 95% CI: 0.78 to 1.02). Further sensitivity analysis indicated that adding anti‐EGFR MoAbs to FOLFOLX regimen as a first‐line treatment showed benefits in both PFS and OS (PFS: HR = 0.74, 95% CI: 0.64 to 0.84; OS: HR = 0.83, 95% CI: 0.73 to 0.95, respectively). Comparing with irinotecan‐based chemotherapy or best supportive care, adding anti‐EGFR MoAbs revealed an improvement in both PFS (HR = 0.77, 95% CI: 0.69 to 0.86; HR = 0.46, 95% CI: 0.40 to 0.54, respectively) and OS (HR = 0.89, 95% CI: 0.80 to 0.98; HR = 0.65, 95% CI: 0.54 to 0.78, respectively). Conclusion Anti‐EGFR MoAbs as a monotherapy or in combination with either irinotecan‐based chemotherapy or FOLFOX in patients with RAS wild‐type mCRC have better response and survival outcome, whereas OS does not benefit from adding anti‐EGFR MoAbs to another oxaliplatin‐based regimen. Anti‐EGFR MoAbs have increased the risk of adverse effects than chemotherapy alone. More high‐quality randomized controlled trials for RAS wild type are necessary.