The role of anti-EGFR agents in patients with locoregionally advanced head and neck cancer: a meta-analysis of randomized trials
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Bum Jun Kim1,2,*, Jae Ho Jeong3,*, Hyeong Su Kim1 and Jung Han Kim1
1Division of Hemato-Oncology, Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
2Division of Internal Medicine, National Army Capital Hospital, The Armed Forces Medical Command, Sungnam, Republic of Korea
3Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
*These authors contributed equally to this work
Keywords: head and neck cancer, anti-EGFR agents, cetuximab, meta-analysis
Received: July 23, 2017 Accepted: September 25, 2017 Published: October 20, 2017
There has been a debate over whether the addition of anti-epidermal growth factor receptor (EGFR) agents to the conventional treatments has beneficial effects in patients with head and neck squamous cell carcinoma (HNSCC). This meta-analysis was performed to investigate the role of anti-EGFR agents in patients with locoregionally advanced HNSCC (LA-HNSCC). A systematic search of the electronic databases was carried out. From eight randomized controlled trials, 2,263 patients were included in the meta-analysis. Compared with chemoradiotherapy (CRT), the addition of an EGFR inhibitor to radiotherapy (RT) or CRT did not improve locoregional control (hazard ratio (HR) = 1.19 [95% confidence interval (CI): 0.99–1.42], P = 0.06), progression-free survival (HR = 1.07 [95% CI: 0.92–1.24], P = 0.37), and overall survival (HR = 1.04 [95% CI, 0.88–1.23], P = 0.65) in patients with LA-HNSCC. Moreover, the addition of anti-EGFR agents increased the risk of skin toxicities (odds ratio = 4.04 [95% CI: 2.51–6.48], P < 0.00001) and mucositis (odds ratio = 1.58 [95% CI: 0.99–2.52], P = 0.06). In conclusion, this meta-analysis indicates that the addition of an anti-EGFR agent to RT or CRT do not improve clinical outcomes compared with CRT in patients with LA-HNSCC. Except for patients with coexisting medical conditions or decreased performance status, concurrent CRT should remain the standard of care for patients with LA-HNSCC.
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