Petrelli Fausto, Ardito Raffaele, Ghidini Antonio, Zaniboni Alberto, Ghidini Michele, Barni Sandro, Tomasello Gianluca
Oncology Unit, Oncology Department, ASST Bergamo Ovest, Treviglio, Italy.
IRCCS Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy.
Oncology. 2018;94(4):191-199. doi: 10.1159/000486338. Epub 2018 Jan 23.
Over the last few years only one large randomized phase III study has tried to prospectively assess the safety of cetuximab and panitumumab in a head-to-head comparison. Despite the similar overall toxicity profile, cetuximab and panitumumab retain peculiar safety characteristics that deserve to be deeply investigated.
We conducted a systematic review for randomized trials in PubMed, the Cochrane Central Register of Controlled Trials, SCOPUS, Web of Science, and EMBASE using the terms ("cetuximab" or "panitumumab") AND ("colorectal cancer" OR "colorectal carcinoma"). Data of adverse events were aggregated to obtain pooled incidence rates of prespecified adverse events. Incidence of skin toxicities was the primary outcome. A χ2 test was used for comparisons of proportions and an odds ratio (OR) was calculated for comparison.
A total of 38 studies were included for analysis. Cetuximab was associated with fewer G3-4 skin toxicities (OR = 0.62, 95% CI 0.53-0.62; p < 0.001), slightly more frequent G3-4 acne-like rash (OR = 1.24, 95% CI 1.04-1.48; p = 0.04), and paronychia (OR 1.36, 95% CI 1.1-1.7), but fewer cases of skin fissures (OR = 0.64, 95% CI 0.44-0.93; p = 0.02) and pruritus (OR = 0.45, 95% CI 0.35-0.58; p < 0.001) than PANI.
In conclusion, this meta-analysis shows that cetuximab- and panitumumab-based chemotherapy have different toxicity profiles in terms of the rate of severe adverse events.
在过去几年中，仅有一项大型随机III期研究试图前瞻性地评估西妥昔单抗和帕尼单抗在直接比较中的安全性。尽管总体毒性特征相似，但西妥昔单抗和帕尼单抗仍具有独特的安全特性，值得深入研究。
我们在PubMed、Cochrane对照试验中央注册库、SCOPUS、科学网和EMBASE中使用术语（“西妥昔单抗”或“帕尼单抗”）以及（“结直肠癌”或“结肠直肠癌”）对随机试验进行了系统评价。汇总不良事件数据以获得预先指定不良事件的合并发生率。皮肤毒性的发生率是主要结局。采用χ2检验进行比例比较，并计算比值比（OR）进行比较。
共纳入38项研究进行分析。与帕尼单抗相比，西妥昔单抗导致的3-4级皮肤毒性更少（OR = 0.62，95%CI 0.53-0.62；p < 0.001），3-4级痤疮样皮疹略更常见（OR = 1.24，95%CI 1.04-1.48；p = 0.04），甲沟炎更多（OR 1.36，95%CI 1.1-1.7），但皮肤皲裂（OR = 0.64，95%CI 0.44-0.93；p = 0.02）和瘙痒（OR = 0.45，95%CI 0.35-0.58；p < 0.001）的病例更少。
总之，这项荟萃分析表明，基于西妥昔单抗和帕尼单抗的化疗在严重不良事件发生率方面具有不同的毒性特征。
