| Purpose The main purpose of this paper is on the clinical efficacy and safety of chemotherapy treatment for metastatic colorectal cancer (mCRC) evaluate the molecular systems targeted drug panitumumab combined with chemotherapy controls to provide reference for clinical program development.Method Searched databases by computer for the PubMed, Cochrane Library, Excerpt Medical Database (Embase), Wanfang Data, VIP Chinese scientific journals database, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and retrieve manually and review of the reference literature. Retrieval time is deadline to March 1,2015. Using Review Manager 5.2 software for Meta analysis. The main outcome measures are response rate (RR), disease control rate (DCR), progression free survival (PFS), overall survival (OS), the incidence of adverse reactions (ARs). Volume effect used by odds ratio (OR), hazard ratio (HR) and 95% Confidence intervals (95%CI). P-values<0.05 were considered statistically significant.Results Totally out of 202, exclude 199 met the inclusion criteria, the final three clinical studies included a total of 2639 cases (1317 cases of the experimental group and 1322 cases of the control group). Interventions in the experimental groups for panitumumab in combination with chemotherapy, the control group was chemotherapy alone. Meta-analysis separately by KRAS genotype showed:in the experimental group of wild-type KRAS gene, the RR (OR=4.57,95%CI:3.28-6.37, P<0.00001), DCR(OR=1.39,95%CI:1.11-1.73, P=0.004), PFS (HR=0.80,95%CI:0.72-0.89, P<0.0001) are superior to the control group, but the OS (HR=0.93,95%CI:0.84-1.04, P=0.19) is not prolonged significantly, The incidence of the Grade 3/4 skin toxicity, diarrhea, paronychia, hypokalemia and hypomagnesemia were higher than the control group significantly. But there is no have sufficient evidence to proved the increased grade 3/4 neutropenia incidence increased. In the experimental group of mutant-type KRAS mCRC, the RR (OR=0.94,95%CI:0.69-1.28, P=0.70), DCR(OR=0.96,95%CI:0.50～1.83, P=0.89), PFS (HR=1.09,95%CI:0.81～1.46, P=0.56), OS (HR=1.04,95%CI:0.83～1.30, P=0.74) are not superior to the control group, The incidence of the grade 3/4 skin toxicity, diarrhea, paronychia, hypokalemia and hypomagnesemia are significantly higher than the control group, but the incidenceof the grade 3/4 neutropenia is lower than the control group.Conclusions The existing Clinical studies have shown that, for the wild-type KRAS mCRC, panitumumab combined with chemotherapy compared with chemotherapy alone can improve the response rate and disease control rate, pro-long the progression free survival, increase the incidence of the grade 3/4 skin toxicity, diarrhea, paronychia, hypokalemia and hypomagnesemia, but without sufficient evidence to show that will prolong overall survival and increased the incidence of the grade 3/4 neutropenia. For the mutant-type KRAS mCRC, panitumumab combined with chemotherapy compared with chemotherapy alone cannot improve the response rate, the disease control rate, do not prolong the progression free survival and the overall survival, but will increase the grade 3/4 skin toxicity, diarrhea, diarrhea, paronychia, hypokalemia and hypomagnesemia incidence, to increase the incidence of the grade 3/4 skin toxicity, diarrhea, diarrhea, paronychia, hypokalemia and hypomagnesemia, but the incidence of the grade 3/4 neutropeniac is not increased. At present, the lack of long-term follow-up for clinical studies, still needs more large, randomized multi-center, high-quality and adequate follow-up period of controlled clinical studies to further confirm. |
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