Cetuximab for esophageal cancer: an updated meta-analysis of randomized controlled trials

• Published in: BMC cancer Vol. 18; no. 1; pp. 1170 - 13
• Main Authors: Huang, Ze-Hao, Ma, Xiao-Wen, Zhang, Jing, Li, Xiao, Lai, Na-Lin, Zhang, Sheng-Xiao
• Format: Journal Article
• Language: English
• Published: London BioMed Central 26.11.2018; BioMed Central Ltd; BMC
• Subjects: Antineoplastic Agents, Immunological - pharmacology; Antineoplastic Agents, Immunological - therapeutic use; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Cancer therapies; Care and treatment; Cetuximab; Cetuximab - pharmacology; Cetuximab - therapeutic use; Chemoradiotherapy; Chemotherapy; Clinical trials; Combined modality therapy; Diarrhea; Disease control; Drug therapy; Epidermal growth factor; Epidermal growth factor receptor; Esophageal cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophagus; Exanthema; Gene amplification; Health Promotion and Disease Prevention; Health risk assessment; Humans; Immunotherapy; Medical and radiation oncology; Medical prognosis; Medicine/Public Health; Meta-analysis; Metastases; Metastasis; Methods; Monoclonal antibodies; Odds Ratio; Oncology; Patient outcomes; Patients; Prognosis; Radiation therapy; Randomized Controlled Trials as Topic; Research Article; Response rates; Surgical Oncology; Survival; Survival Analysis; Targeted cancer therapy; Treatment Outcome; Tumors; Cetuximab; Esophageal cancer; Epidermal growth factor receptor; Meta-analysis
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-018-5040-z

Background Increasing 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. Methods A 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. Results This 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. Conclusions Our 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.