Abstract
748 Background: Majority of advanced colorectal cancer (CRC) patients with liver limited disease (LLD) that undergo curative partial liver resection relapse within 5 years. Peri-operative chemotherapy is currently utilized, however the benefit of this is modest only. The addition of anti-EGFR therapy with cetuximab to chemotherapy has consistently demonstrated improvements in objective response rate (ORR) but its impact on potentially curative R0 resection, progression free survival (PFS) and overall survival (OS) remains debatable. The aim of this study was to evaluate the evidence for the use of cetuximab with chemotherapy, in the peri-operative setting for patients with advanced KRAS-WT CRC and unresectable LLD. Methods: Comprehensive literature search was conducted using PubMed and MEDLINE. Inclusion criteria identified studies evaluating the efficacy of chemotherapy and cetuximab vs. chemotherapy alone in advanced KRAS-WT CRC with unresectable LLD. Phase II studies evaluating chemotherapy-cetuximab without control arms were also included. Pooled data was included in meta-analysis and analysed using the Stata v.7. The primary endpoint was the R0 resection rate. Secondary endpoints were ORR, PFS and OS. Results: 5 trials, describing a total of 617 patients, were included in the analysis1–5. Patients receiving cetuximab in addition to chemotherapy were more likely to achieve R0 resection than patients receiving chemotherapy alone (OR 2.13; 95% CI 1.23-3.68, p < 0.05). Patients on cetuximab had improved ORR compared to patients not on cetuximab (OR 2.59; 95% CI 1.74-3.87, p < 0.05). Patients receiving cetuximab had a mean PFS 3.1 months higher than patients not on cetuximab (95% CI 2.76-3.45, p < 0.05). Patients on cetuximab also had a mean OS 0.67 months longer than those not on cetuximab (95% CI 0.44-0.91, p < 0.05). Conclusions: The addition of cetuximab to chemotherapy in the treatment of advanced KRAS-WT CRC with unresectable LLD leads to better outcomes compared to chemotherapy alone.
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