Anti-EGFR Monoclonal Antibodies Plus Oxaliplatin Or Irinotecan Based Chemotherapy In Metastatic Colorectal Cancer,a Meta-analysis

PurposeThis study intended to assess the efficacy and safety of anti-EGFR monoclonal antibodies (mAb) plus oxaliplatin or irinotecan based chemotherapy in metastatic colorectal cancer.MethodsIn Pubmed, EMBASE, The Cochrane library and ClinicalTrials.gov Database, we searched and selected randomized clinical trials that qualified the included criteria. Then extraction and assessment of data from eligible studies for the meta-analysis were performed according to The Cochrane Handbook5.1.0. The outcomes were overall response rate (ORR), disease control rate (DCR), progression free survival (PFS), overall survival (OS) and grade3/4advent events (AEs). And all of those outcomes excluded grade3/4AEs were also computed under a subgroup concerning KRAS status.Results Six randomized clinical trials with1100patients were qualified to this meta-analysis. There were no significant differences in response rate as ORR (RR=1.09,95%CI0.96-1.25) and DCR (RR=1.0595%CI1.00-1.16) between oxaliplatin and irinotecan based chemotherapy plus anti-EGFR mAb. The subgroups of these two arms concerning KRAS wild type (KRAS wt) such as ORR (RR=0.95,95%CI0.77-1.17), DCR (RR=1.05,95%CI0.87-1.28) and KRAS mutation type (KRAS mt) such as ORR (RR=1.21,95%CI0.88-1.68), DCR (RR=1.04,95%CI0.89-1.22) showed no significant differences as well. There were no statistically differences in survival as PFS (HR=1.0195%CI0.79-1.21) and OS (HR=1.02,95%CI0.78-1.34) comparing oxaliplatin based chemotherapy plus anti-EGFR mAb with irinotecan based chemotherapy plus the same antibody. The subgroup of KRAS wt as PFS (HR=1.03,95%CI0.79-1.33), OS (HR=0.82,95%CI0.77-1.30) and that of KRAS mt as PFS (HR=0.96,95%CI0.74-1.24), OS (HR=1.31,95%CI0.32-1.68) were also no significant differences. But oxaliplatin based chemotherapy plus anti-EGFR mAb statistically demonstrated poor tolerance of3/4grade thrombocytopenia (RR=9.18,95%CI1.69-49.87),3/4grade neuropathy (RR=9.06,95%CI2.49-32.94) and3/4grade allergic reaction (RR=3.01,95%CI:1.22-7.43). And there were no significant difference in grade3/4neutropenia (RR=1.19,95%CI0.88-1.61), grade3/4diarrhea (RR=0.86,95%CI0.65-1.14), and grade3/4skin toxicity (RR=1.06,95%CI0.71-1.57) between two chemotherapy regimens.ConclusionsEfficacy balanced between oxaliplatin and irinotecan based chemotherapy plus anti-EGFR mAb, and safer application of irinotecan determined irinotecan based chemotherapy plus anti-EGFR mAb as a better decision of treatment regimen.