A Meta-analysis Of Clinical Trials Over Regimens With Or Without Cetuximab For Advanced Gastric Cancer Patients

BackgroundThe morbidity and mortality of gastric cancer continues to decline in recent years.However,gastric cancer is still the third common cancer in the world.It is one of the leading causes of cancer-related death globally.There are several kinds of gastric cancer treatments such as surgery,radiotherapy and chemotherapy.Resection of disease has been accepted as one of the most important and effective treatments.However,most patients are diagnosed as AGC,which bears poor prognosis with only 10-15%of 5-year survival.Therefore,treatment of AGC remains challenging.In order to improve survival outcomes of patients with AGC,several studies were conducted to compare chemotherapy with or without cetuximab.Cetuximab is a recombinant chimeric monoclonal antibody directed against the human epidermal growth factor receptor(EGFR).Increased levels of EGFR have been associated with poor prognosis in gastric cancer.Overexpression of EGFR has been reported in AGC and gastric cancer seems to be a good candidate for chemotherapy combined with anti-EGFR drugs.Based on the above research results,we can infer that both chemotherapy with or without cetuximab are effective treatment methods to improve the survival of patients with gastric cancer.But patients subjected to chemotherapy combined with cetuximab suffer of higher toxicity and higher treatment cost than when receiving chemotherapy alone.The efficiency of the two kinds of therapies is still unclear.To choose the best treatment plan for patients diagnosed with AGC,we performed a meta-analysis of all available published RCTs and evaluated the efficacy of the two treatment meth ods and the safety of cetuximab.MethodsRandomized phase ? clinical trials(RCTs)on chemotherapy with or without cetuximab for AGC were searched in PUBMED and CNKI.A total of 874 patients were analyzed for their overall survival(OS),disease control rate(DCR),and toxicity.Reported hazard ratio(HR)with 95%CI from each study were used as the primary outcome measure.ResultsThree RCTs were detected on chemotherapy with or without cetuximab regimens for AGC.Chemotherapy plus cetuximab was not significantly advantageous over chemotherapy alone for OS rate and DCR odds ratio(OR)(OS:OR=0.89,95%CI=0.50-1.56;DCR:OR=1.11,95%CI=0.78-1.59).However,haematological toxicity and neutropenia were lower in the experimental group(chemotherapy plus cetuximab)than in the control group(chemotherapy alone)(OR=0.65,95%CI=0.50-0.84).No evidence of publication bias was found in this study.ConclusionsAdding cetuximab to chemotherapy does not improve OS or DCR compared with chemotherapy alone.Cetuximab-containing combination chemotherapy can reduce the risk of neutropenia.