Department of Oncology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, No. 301 Middle Yanchang Road, Zhabei District, Shanghai, 200072, China.
Int J Cancer. 2015 Feb 15;136(4):936-44. doi: 10.1002/ijc.29045. Epub 2014 Jul 8.
The role of cetuximab in treatment-related hematologic toxicity is not clear. We performed a meta-analysis of published randomized controlled trials (RCTs) to determine the overall risk of ≥grade 3 hematologic toxicity events (HTEs) associated with cetuximab. PubMed, EMBASE, and Web of Knowledge databases as well as abstracts presented at American Society of Clinical Oncology conferences and ClinicalTrials.gov were searched to identify relevant studies. Eligible studies included RCTs in which cetuximab in combination with chemotherapy or chemoradiotherapy was compared with chemotherapy or chemoradiotherapy alone. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. A total of 11,234 patients with a variety of advanced solid tumors from 18 RCTs were included in the meta-analysis. Compared with chemotherapy alone, the addition of cetuximab was associated with increased risks of ≥grade 3 leucopenia/neutropenia and anemia events in colorectal cancer, with RRs of 1.16 (95% CI 1.05-1.27, p=0.002; incidence, 21.0 vs. 18.0%) and 2.67 (95% CI 1.53-4.65, p=0.01; incidence, 4.0 vs. 2.0%), respectively. Cetuximab was also associated with an increased risk of leucopenia/neutropenia in nonsmall cell lung cancer (NSCLC) (RR: 1.15; 95% CI 1.08-1.22, p<0.01). Additionally, K-ras wild type in the case of colorectal cancer patients was more vulnerable to ≥grade 3 leucopenia or neutropenia events in cetuximab group (RR: 1.31; 95% CI 1.11-1.54, p=0.001). With present evidence, cetuximab in conjunction with chemotherapy or chemoradiotherapy, compared with chemotherapy or chemoradiotherapy alone, was associated with increased slight risk of ≥grade 3 HTEs, especially in colorectal cancer and NSCLC.
西妥昔单抗在治疗相关血液学毒性中的作用尚不清楚。我们进行了一项荟萃分析，以确定与西妥昔单抗相关的≥3 级血液学毒性事件（HTE）的总体风险。检索了 PubMed、EMBASE 和 Web of Knowledge 数据库以及美国临床肿瘤学会会议的摘要和 ClinicalTrials.gov，以确定相关研究。纳入的研究包括西妥昔单抗联合化疗或放化疗与单纯化疗或放化疗比较的随机对照试验（RCT）。使用固定或随机效应模型计算相对风险（RR）和 95%置信区间（CI）。共纳入 18 项 RCT 中的 11234 例各种晚期实体瘤患者进行荟萃分析。与单纯化疗相比，西妥昔单抗联合化疗与增加结直肠癌≥3 级白细胞减少/中性粒细胞减少和贫血事件的风险相关，RR 分别为 1.16（95%CI 1.05-1.27，p=0.002；发生率，21.0%比 18.0%）和 2.67（95%CI 1.53-4.65，p=0.01；发生率，4.0%比 2.0%）。西妥昔单抗还与非小细胞肺癌（NSCLC）的白细胞减少/中性粒细胞减少风险增加相关（RR：1.15；95%CI 1.08-1.22，p<0.01）。此外，结直肠癌患者的 K-ras 野生型在西妥昔单抗组中更容易发生≥3 级白细胞减少或中性粒细胞减少事件（RR：1.31；95%CI 1.11-1.54，p=0.001）。目前的证据表明，与单独化疗或放化疗相比，西妥昔单抗联合化疗或放化疗与增加的轻微的≥3 级 HTE 风险相关，特别是在结直肠癌和 NSCLC 中。
