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Impact of Anti-EGFR Therapies on HER2-Positive Metastatic Colorectal Cancer: A Systematic Literature Review and Meta-Analysis of Clinical Outcomes.
- Source :
- Oncologist; Oct2023, Vol. 28 Issue 10, p885-893, 9p, 1 Diagram, 3 Charts, 2 Graphs
- Publication Year :
- 2023
-
Abstract
- Background HER2 overexpression/amplification in patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC) may be associated with resistance to standard-of-care anti-EGFR therapies. Given the lack of comprehensive investigations into this association, we assessed the prognostic or predictive effect of HER2 amplification/overexpression on anti-EGFR treatment outcomes. Methods A systematic review of MEDLINE, Embase, and Cochrane Library (2001-2021) identified studies evaluating progression-free survival (PFS), overall response rate (ORR), and overall survival (OS) in HER2-positive vs. HER2-negative patients with RAS WT mCRC who received anti-EGFR treatments and whose HER2 status was known. Meta-analyses of proportions (ORR) and hazard ratios (PFS, OS) were performed using random-effect models with pre-specified sensitivity analyses. Results Five high-quality retrospective cohort studies were included in the meta-analyses representing 594 patients with mCRC. All patients received anti-EGFR treatment, either as monotherapy or in combination with chemotherapy. Meta-analysis of PFS demonstrated a 2.84-fold higher risk of death or progression (95% CI, 1.44-5.60) in patients with HER2-positive (vs. HER2-negative) RAS WT mCRC treated with anti-EGFR regimens. The odds of response to anti-EGFR treatment were 2-fold higher in HER2-negative vs. HER2-positive (odds ratio, 1.96 [95% CI, 1.10-3.48]). Differences in OS were not statistically significant. Sensitivity analyses confirmed the robustness of the base-case estimates. Conclusions While this study could not account for all confounding factors, in patients with RAS WT mCRC who received anti-EGFR therapy, HER2 overexpression/amplification was associated with worse PFS and ORR and may therefore predict poorer outcomes. HER2 testing is important to inform treatment decisions and could optimize outcomes for patients. [ABSTRACT FROM AUTHOR]
- Subjects :
- MEDICAL databases
META-analysis
MEDICAL information storage & retrieval systems
CONFIDENCE intervals
EPIDERMAL growth factor receptors
METASTASIS
RETROSPECTIVE studies
COLORECTAL cancer
TREATMENT effectiveness
GENE expression
DECISION making
DESCRIPTIVE statistics
RESEARCH funding
MEDLINE
PROGRESSION-free survival
SENSITIVITY & specificity (Statistics)
OVERALL survival
Subjects
Details
- Language :
- English
- ISSN :
- 10837159
- Volume :
- 28
- Issue :
- 10
- Database :
- Complementary Index
- Journal :
- Oncologist
- Publication Type :
- Academic Journal
- Accession number :
- 173516828
- Full Text :
- https://doi.org/10.1093/oncolo/oyad200