Azienda Ospedaliera Treviglio-Caravaggio, Treviglio (BG), Italy.
Int J Colorectal Dis. 2011 Jul;26(7):823-33. doi: 10.1007/s00384-011-1149-0. Epub 2011 Feb 1.
Anti-epidermal growth factor receptor monoclonal antibodies (panitumumab [P] and cetuximab [C]) are approved and effective only in KRAS wild-type patients with advanced colorectal cancer. The purpose of our meta-analysis is to evaluate the real effects of C and P in KRAS wild-type patients treated in randomized trials.
Eligible studies included prospective, randomized, and controlled trials in which either C or P had been added to standard antineoplastic therapy or best supportive care and data for KRAS wild-type patients only had been calculated. Six thousand three hundred ninety-five patients' tumor samples have been analyzed (total wild-type n = 3,254; experimental arm n = 1,608; control arm n = 1,646). Relative risks (RRs) with 95% confidence intervals (CIs) for response rate were calculated, as well as hazard ratios (HRs)for progression-free survival (PFS) and overall survival.
The overall RR of response rate is 1.69 (p = 0.003) in all trials. The overall HRs for PFS and survival are 0.65 (p = 0.0006) and 0.84 (p = 0.03), respectively, and both are significant. The HRs for PFS and survival in C trials are 0.64 and 0.79, respectively, and 0.65 and 0.87, respectively, in P trials, although only the results achieved in P trials are significant (p = 0.0007 and p = 0.03). Both response rate (RR = 10.94) and PFS (HR = 0.51) have increased more in pretreated patients than in first-line trials.
The addition of anti-EGFR monoclonal antibodies to standard anticancer therapy in KRAS wild-type colorectal cancer showed an overall significantly increased risk of objective response rate and increased progression-free and overall survival. Only the results achieved in P randomized trials are significant, and the strongest results have been achieved in pretreated patients.
抗表皮生长因子受体单克隆抗体（panitumumab [P] 和 cetuximab [C]）仅在晚期结直肠癌的 KRAS 野生型患者中被批准并证明有效。本荟萃分析的目的是评估在随机试验中接受治疗的 KRAS 野生型患者中 C 和 P 的实际效果。
纳入的研究包括前瞻性、随机、对照试验，其中 C 或 P 已被添加到标准抗肿瘤治疗或最佳支持治疗中，并且仅计算了 KRAS 野生型患者的数据。对 6395 名患者的肿瘤样本进行了分析（总野生型 n = 3254；实验组 n = 1608；对照组 n = 1646）。计算了应答率的相对风险（RR）及其 95%置信区间（CI），以及无进展生存期（PFS）和总生存期的风险比（HR）。
所有试验的总应答率 RR 为 1.69（p = 0.003）。PFS 和生存的总 HR 分别为 0.65（p = 0.0006）和 0.84（p = 0.03），均具有统计学意义。C 试验的 PFS 和生存 HR 分别为 0.64 和 0.79，P 试验的 HR 分别为 0.65 和 0.87，尽管只有 P 试验的结果具有统计学意义（p = 0.0007 和 p = 0.03）。与一线试验相比，预处理患者的应答率（RR = 10.94）和 PFS（HR = 0.51）增加更多。
在 KRAS 野生型结直肠癌中，将抗 EGFR 单克隆抗体添加到标准抗癌治疗中显示出总应答率显著增加，并且 PFS 和总生存期增加。只有 P 随机试验的结果具有统计学意义，并且在预处理患者中取得了最强的结果。
