Abstract
Purpose. Our study analyses clinical trials and evaluates the efficacy of adding cetuximab in systematic chemotherapy for unresectable colorectal cancer liver-confined metastases patients. Materials and Methods. Search EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials for RCTs comparing chemotherapy plus cetuximab with chemotherapy alone for KRAS wild type patients with colorectal cancer liver metastases (CRLMs). We calculated the relative risks (RRs) with 95% confidence interval and performed meta-analysis of hazard ratios (HRs) for the R0 resection rate, the overall response rate (ORR), the progression-free survival (PFS) and overall survival (OS). Results. 1173 articles were retrieved and 4 RCTs were available for our study. The four studies involved 504 KRAS wild type patients with CRLMs. The addition of cetuximab significantly improved all the 4 outcomes: the R0 resection rate (RR 2.03, p = 0.004), the ORR (RR 1.76, p < 0.00001), PFS (HR 0.63, p < 0.0001), and also OS (HR 0.74, p = 0.04); the last outcome is quite different from the conclusion published before. Conclusions. Although the number of patients analysed was limited, we found that the addition of cetuximab significantly improves the outcomes in KRAS wild type patients with unresectable colorectal cancer liver-confined metastases. Cetuximab combined with systematic chemotherapy perhaps suggests a promising choice for KRAS wild type patients with unresectable liver metastases.
Highlights
Liver is well known as the most common site of colorectal cancer metastasis
The results of our metaanalysis showed that the rate of radical resection of liver metastases was significantly increased from 8.7% to 17.6% by the use of cetuximab (RR 2.03, 95% confidence interval (CI) 1.25–3.29; p = 0.004; Figure 2)
The results of our meta-analysis showed that the likelihood of response of the liver metastases was significantly increased from 37.4% to 65.6% by the use of cetuximab (RR 1.76, 95% CI 1.40–2.21; p < 0.00001; Figure 3)
Summary
Liver metastases have already been found in about 25% patients when establishing the diagnosis of colorectal cancer [1]. Colorectal cancer liver metastasis has already become a focused point for the researchers recently. Surgery is an effective measure to improve survival rate for patients with resectable metastases. Only about 10% patients with colorectal cancer liver metastases (CRLMs) are accessible to get a surgery treatment at the time of diagnosis [2], and at least two-thirds of the rest of 90% patients died for the reason of unresectable CRLMs (5-year survival rate is almost zero) [3]. KRAS is an effector gene in the downstream of EGFR, a paper reported that patients with KRAS mutant type could not benefit from adjuvant chemotherapy and were not sensitive to Gastroenterology Research and Practice
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