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Meta-Analysis
. 2011 Dec 1;11(4):317-26.
doi: 10.2165/11598190-000000000-00000.

Incidence and risk of severe neutropenia in advanced cancer patients treated with cetuximab: a meta-analysis

Long Wang  1 , Yi-Zhi Chen, Duo Shi, Xue-Yin Shi, Zui Zou, Jian-Hua Zhao
Affiliations
Meta-Analysis

Incidence and risk of severe neutropenia in advanced cancer patients treated with cetuximab: a meta-analysis

Long Wang et al. Drugs R D. .

Abstract

Background and aim: Neutropenia is a serious adverse event for patients who are treated with cetuximab, an inhibitor of endothelial growth factor receptor. However, there is no consistent result of the relationship between cetuximab and neutropenia in randomized controlled trials (RCTs). We did a systematic review and meta-analysis of published RCTs to assess the overall risk of neutropenia associated with cetuximab.

Methods: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and American Society of Clinical Oncology conferences were searched for relevant RCTs. Quantitative and qualitative analyses were carried out to evaluate the association between neutropenia and cetuximab. Both the fixed-effect model and random-effects model were used.

Results: A total of 7186 patients with a variety of advanced cancers from 14 trials were included in our analysis. The overall incidence of neutropenia in patients receiving cetuximab was 33% (95% CI 26, 43). Patients treated with cetuximab had a significantly increased risk of neutropenia compared with patients treated with control medication, with a relative risk (RR) of 1.12 (95% CI 1.05, 1.19; fixed-effect model). Risk varied with tumor type. Higher risks were observed in patients with colorectal carcinoma (RR 1.17; 95% CI 1.04, 1.32; fixed-effect model) and non-small cell lung cancer (RR 1.07; 95% CI 0.99, 1.16; fixed-effect model).

Conclusion: Cetuximab is associated with a significant risk of neutropenia in patients with advanced cancer receiving concurrent chemotherapy.

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Figures

Fig. 1
Fig. 1
Selection process for RCTs included in the meta-analysis. RCT = randomized controlled trial.
Table I
Table I
Characteristics of randomized controlled clinical trials included in the meta-analysis
Fig. 2
Fig. 2
Relative risk (RR) of neutropenia associated with cetuximab treatment compared with control treatment. An RR <1 means a numerically lower incidence than control chemotherapy and an RR >1 means a numerically higher incidence than control chemotherapy. If the lower value of the 95% CI range is greater than 1, it means that there is a statistically significant difference between the two groups. Conversely, a value of 1 or smaller indicates non-significance.
Fig. 3
Fig. 3
Comparison of incidence between cetuximab groups and control groups. 64% of all included trials reported patients treated with cetuximab had a numerically higher incidence of neutropenia, while 29% were lower, and 7% were equal.
Table II
Table II
Incidence of neutropenia with cetuximab among patients with various tumor types
Fig. 4
Fig. 4
Funnel plot analysis to detect publication bias. RR = relative risk; se = standard error.
See this image and copyright information in PMC

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