Efficacy And Safety In Advanced Upper Gastrointestinal Tract Cancer Patients Receiving Anti-EGFR Monoclonal Antibodies Regimens:A Meta-analysis

ObjectiveThe overexpression of EGFR (Epidermal Growth Factor Recepter) in oesophagogastric cancers reaches up to 55% and is associated with poor prognosis. We aim to evaluate the efficacy and safety of anti-epidermal growth factor receptor monoclonal antibodies (anti-EGFR MoAbs) therapy versus non-anti-EGFR MoAbs therapy for advanced oesophagogastric (OG) cancer.Materials and MethodsPubMed, Cochrane Library, Web of Science, EMbase, and abstracts presented at American Society of Clinical Oncology (ASCO) were systematically searched for relevant studies to compare the same therapeutic regimens with or without anti-EGFR MoAbs for OG cancer until December 21,2015. Analysis was carried out to assess the overall response rate (ORR), overall survival (OS), progression free survival (PFS), and grade 3-4 adverse effects (AEs).ResultsNine studies involving 2157 patients were included. Primary meta-analysis indicated that Anti-EGFR MoAbs therapy could improve ORR (RR 1.19,95% CI 1.01-1.40). Among the patients with EGFR overexpression (1+/2+/3+), anti-EGFR MoAbs therapy showed obvious improvement with OS (HR 0.54,95%CI 0.30-0.96), but failed to improve PFS (HR 0.64,95% CI 0.38-1.06). For the patients with EGFR unselected, anti-EGFR MoAbs group was inferior to control group in OS (HR 1.13, 95% CI 1.01-1.26) and PFS (HR 1.15,95% CI 1.03-1.291). Analysis of adverse effects showed that rash (RR 20.59,95% CI 7.58-55.92), hand-foot syndrome (RR 2.06,95%CI 1.30-3.25), and diarrhea (RR 1.79,95%CI 1.35-2.37) were significantly associated with anti-EGFR MoAbs therapy. On the contrary, anti-EGFR MoAbs therapy could lower the risk of neutropenia (RR 0.680.57-0.80).ConclusionsBased on the present evidence, anti-EGFR MoAbs therapy could improve ORR among patients with advanced OG cancer. For survival analysis, the therapy of anti-EGFR MoAbs therapy was ineffective for patients with EGFR unselected. However, it showed potential improvement in the patients with EGFR overexpression (1+/2+/3+) based on improved OS. During anti-EGFR MoAbs therapy, some dermatological reactions, like rash and hand-foot syndrome and some gastrointestinal reactions, such as diarrhea should be monitored carefully.