Abstract
BackgroundIncreasing evidence indicates that cetuximab (CET) combined with chemoradiotherapy may be effective for patients with esophageal cancer. However, the recent results are still contradictory and no consensus has yet been reached on this issue. To evaluate the clinical effects and safety of CET, we conducted an updated meta-analysis by retrieving published data up to June 2018.MethodsA comprehensive literature search was performed in several electronic databases, including PubMed, Embase, the Cochrane Library, CNKI database and Chinese Biomedicine Database using subject terms and free terms. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the efficiency and safety of CET.ResultsThis meta-analysis included 10 randomized controlled trials (RCTs). Five RCTs reported localized esophageal cancer and other five RCTs reported metastatic esophageal cancer. For these patients with localized esophageal cancer, CET could not significantly improve the response rate, overall survival and progression-free survival (PFS, 1–5 years). But CET treatment might increase the incidences of diarrhea (OR = 2.07; CI = 1.01–4.25) and rash (OR = 16.91; CI = 3.20–89.42). For other patients with metastatic esophageal cancer, the addition of CET significantly increased the response rate (OR = 3.34; CI = 1.90–5.88), disease control rate (OR = 2.92; CI = 1.49–5.71) and 2-year overall survival (OR = 2.78; CI = 1.20–6.46) compared with the control group. However, CET could not improve the 1-year overall survival and might make patients with metastatic esophageal cancer more susceptible to rash (OR = 5.50; CI = 2.14–14.14). No significant differences in other adverse effects were found between the two groups.ConclusionsOur findings suggested that adding CET to multimodal therapy significantly improved response rate and disease control rate for patients with metastatic esophageal cancer rather than patients with localized esophageal cancer. CET might be a safe therapeutic choice, but CET failed to significantly improve the overall survival and PFS for patients with localized or metastatic esophageal cancer.
Highlights
Increasing evidence indicates that cetuximab (CET) combined with chemoradiotherapy may be effective for patients with esophageal cancer
Increasing evidence has indicated that CET may help treat various cancers, including non-small cell lung cancer (NSCLC) [21], colorectal adenocarcinomas [12] and squamous cell head and neck cancer [13], especially esophageal cancer
Based on the outcomes reported in these included randomized controlled trials (RCTs), we pooled the data of overall survival, progression-free survival (PFS), response rate, disease control rate and various Adverse effects (AEs) according to the disease status
Summary
Increasing evidence indicates that cetuximab (CET) combined with chemoradiotherapy may be effective for patients with esophageal cancer. Esophageal cancer, mainly includes esophageal adenocarcinoma and esophageal squamous cell carcinoma (ESCC), is a kind of malignant tumor threatening human health seriously. It has become the 8th most common cancer type and the 6th leading cause of cancer mortality [1] with. In the 1990s, the results of RTOG 85-01 established the standard care for the nonoperative treatment in localized esophageal cancer using concurrent chemoradiotherapy [3, 4]. Increasing studies have found various biologic markers in esophageal cancer, including epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and HER-2 [7]. EGFR is overexpressed in approximately one third [8] to half [9] of esophageal adenocarcinomas and 71% of ESCC [10] and is associated with poor prognosis [11]
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