Medical Oncology Unit, Oncology department, Azienda Ospedaliera Treviglio Caravaggio, Piazzale Ospedale 1, 24047 Treviglio, BG, Italy.
Int J Colorectal Dis. 2012 Aug;27(8):997-1004. doi: 10.1007/s00384-012-1438-2. Epub 2012 Feb 23.
Cetuximab (C) and panitumumab (P) increase response rate and survival in KRAS wild-type metastatic colorectal cancer (mCRC). We performed a meta-analysis of randomised controlled trials (RCTs) to assess their effect on overall response rate (ORR), the rate of radical resection (R0) and survival in patients with liver-limited initially unresectable mCRC.
We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for RCTs comparing first-line chemotherapy plus or minus C or P and reporting data in patients with KRAS wild-type, unresectable liver-limited mCRC. Relative risks (RRs) with 95% confidence interval were calculated. Meta-analysis of hazard ratios (HRs) for progression-free and overall survival (PFS and OS) was also performed.
Four RCTs involving 484 KRAS wild-type patients were included. Compared to chemotherapy alone, the addition of C or P significantly increased the ORR (RR 1.67, p = 0.0001), the R0 resection rate from 11% to 18% (RR 1.59, p = 0.04) and PFS (HR 0.68, p = 0.002), but not OS (p = 0.42).
The addition of C and P increased the R0 resection rate by 60% and reduced the risk of progression by 32% in patients with mCRC and unresectable liver-limited disease. This combination represents one of the preferred choices as conversion therapy in KRAS wild-type patients with unresectable liver metastases.
西妥昔单抗（C）和帕尼单抗（P）增加了 KRAS 野生型转移性结直肠癌（mCRC）的反应率和生存率。我们进行了一项随机对照试验（RCT）的荟萃分析，以评估其对总体反应率（ORR）、根治性切除率（R0）和肝有限初不可切除 mCRC 患者的生存的影响。
我们检索了 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库，以比较一线化疗加或不加 C 或 P，并报告 KRAS 野生型、不可切除肝有限 mCRC 患者的数据。计算了相对风险（RR）和 95%置信区间。还对无进展和总生存（PFS 和 OS）的风险比（HR）进行了荟萃分析。
纳入了四项涉及 484 例 KRAS 野生型患者的 RCT。与单独化疗相比，添加 C 或 P 显著增加了 ORR（RR 1.67，p = 0.0001）、R0 切除率从 11%增加到 18%（RR 1.59，p = 0.04）和 PFS（HR 0.68，p = 0.002），但不包括 OS（p = 0.42）。
在 mCRC 和不可切除肝局限性疾病患者中，添加 C 和 P 可将 R0 切除率提高 60%，并将进展风险降低 32%。对于不可切除肝转移的 KRAS 野生型患者，这种联合治疗是一种首选的转化治疗选择。
