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Meta-Analysis
. 2022 Aug 15;20(1):258.
doi: 10.1186/s12957-022-02707-x.

Efficacy and safety of triplet chemotherapy plus anti-EGFR agents in metastatic colorectal cancer: a systematic review and meta-analysis

Qian Wu  1 , Huan Wang  1 , Suqin Zhang  1 , Yifei Zeng  1 , Wei Yang  1 , Wenjun Pan  1 , Guodai Hong  1 , Wenbin Gao  2
Affiliations
Meta-Analysis

Efficacy and safety of triplet chemotherapy plus anti-EGFR agents in metastatic colorectal cancer: a systematic review and meta-analysis

Qian Wu et al. World J Surg Oncol. .

Abstract

Background: To date, the optimal treatment for potentially resectable metastatic colorectal cancer (mCRC) patients has yet to be determined. Encouraging results have been reported in studies exploring the efficacy of triplet chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) target agents. Thus, we conducted a meta-analysis to evaluate the efficacy and safety of triplet chemotherapy plus anti-EGFR target agents.

Methods: We systematically searched the PubMed, Embase, and Web of Science databases from December 2004 to October 2021 for studies examining the efficacy of triplet chemotherapy plus anti-EGFR target agents in mCRC patients. The primary outcomes were the objective response rate (ORR) and R0 resection rate (R0RR), and the secondary outcomes were median progression-free survival (mPFS), median overall survival (mOS), and toxicity. Data were analyzed with R software 4.1.2.

Results: Fourteen studies comprising 762 patients with mCRC were included in this meta-analysis. Analysis with a random effects model revealed that after treatment with triplet chemotherapy plus anti-EGFR target agents, the pooled ORR was 82% (95% CI= 76-88%, I2= 76%), and the pooled R0RR of colorectal liver metastasis (CLM) was 59% (95% CI= 49-68%, I2= 60%). The mPFS ranged from 9.5 to 17.8 months, and the mOS ranged from 24.7 to 62.5 months. A total of 648 grade 3 or 4 adverse events were reported; the most commonly reported events were diarrhea (174/648), neutropenia (157/648), and skin toxicity (95/648), which had pooled prevalence rates of 29% (95% CI= 20-39%, I2= 84%), 28% (95% CI= 20-37%, I2= 77%), and 17% (95% CI= 11-24%, I2= 66%), respectively.

Conclusions: Triplet chemotherapy plus anti-EGFR agents therapy seems to be capable of increasing the ORR of mCRC patients and the R0RR of CLM patients. The toxicity of this treatment is manageable. High-quality randomized controlled trial (RCT) studies are required for further validation.

Keywords: Anti-EGFR; Cetuximab; Metastatic colorectal cancer; Panitumumab; Triplet chemotherapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search and study selection
Fig. 2
Fig. 2
Forest plot of ORR in mCRC patients treated with triplet chemotherapy plus an anti-EGFR. ORR, objective response rate; mCRC, metastasis colorectal cancer
Fig. 3
Fig. 3
Forest plot of R0RR in CLM patients treated with triplet chemotherapy plus an anti-EGFR. R0RR, R0 resection rate; CLM, colorectal liver metastasis
Fig. 4
Fig. 4
Forest plot of grade3/4 diarrhea in mCRC patients treated with triplet chemotherapy plus anti-EGFR. ORR, objective response rate; mCRC, metastatic colorectal cancer
Fig. 5
Fig. 5
Forest plot of grade3/4 neutropenia in mCRC patients treated with triplet chemotherapy plus anti-EGFR. ORR, objective response rate; mCRC, metastatic colorectal cancer
Fig. 6
Fig. 6
Forest plot of grade3/4 skin toxicity in mCRC patients treated with triplet chemotherapy plus anti-EGFR. ORR, objective response rate; mCRC, metastatic colorectal cancer
Fig. 7
Fig. 7
Funnel plot of ORR in mCRC patients treated with triplet chemotherapy plus anti-EGFR. ORR, objective response rate; mCRC, metastatic colorectal cancer
Fig. 8
Fig. 8
Egger’s test of ORR in mCRC patients treated with triplet chemotherapy plus anti-EGFR. ORR, objective response rate; mCRC, metastatic colorectal cancer
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