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Meta-Analysis
. 2013 Nov 28;8(11):e81897.
doi: 10.1371/journal.pone.0081897. eCollection 2013.

Incidence and risk of treatment-related mortality with anti-epidermal growth factor receptor monoclonal antibody in cancer patients: a meta-analysis of 21 randomized controlled trials

Xing Li  1 , Bao-En Shan, Juan Wang, Lian-Ping Xing, Xiao-Jin Guo, Yue-Hua Zhang, Peng-Hui Shi, Zhi-Yu Wang
Affiliations
Meta-Analysis

Incidence and risk of treatment-related mortality with anti-epidermal growth factor receptor monoclonal antibody in cancer patients: a meta-analysis of 21 randomized controlled trials

Xing Li et al. PLoS One. .

Abstract

Background: Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (MoAbs) cetuximab and panitumumab have emerged as an effective targeted therapy in the treatment of cancer patients, but the overall incidence and risk of fatal adverse events (FAEs) associated with these agents is still unclear.

Methods: Databases from PubMed, Web of Science and abstracts presented at ASCO meeting up to May 31, 2013 were searched to identify relevant studies. Eligible studies included prospective randomized controlled trials evaluating MoAbs in cancer patients with adequate data on FAEs. Statistical analyses were conducted to calculate the summary incidence, odds ratio and 95% confidence intervals (CIs) by using either random effects or fixed effect models according to the heterogeneity of included studies.

Results: A total of 14,776 patients with a variety of solid tumors from 21 clinical trials were included in our analysis. The overall incidence of MoAbs associated FAEs was 1.7% (95%CI: 1.1-2.5%), and the incidence of cetuximab-related FAEs was higher than that of panitumumab (2.0% versus 0.9%). Compared with the controls, the use of MoAbs was associated with a significantly increased risk of FAEs, with an OR of 1.37 (95%CI: 1.04-1.81, p=0.024). Subgroup analysis based on EGFR-MoAbs drugs, phase of trials and tumor types demonstrated a tendency to increase the risk of FAEs, but the risk did not increase in breast cancer, esophagus cancer and phase II trials.

Conclusions: With present evidence, the use of EGFR-MoAbs is associated with an increased risk of FAEs in patients with advanced solid tumors.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of trial selection process in the meta-analysis.
Figure 2
Figure 2. Forest plot for meta-analysis of incidence of FAEs in cancer patients assigned EGFR-MoAbs.
Figure 3
Figure 3. Odds ratio of EGFR-MoAbs associated FAEs versus control from randomized controlled trials of patients with cancer.
Figure 4
Figure 4. Meta-analysis of FAEs associated with EGFR-MoAbs versus control: ‘leave-one-out’ sensitivity analysis.
See this image and copyright information in PMC

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