EGFR Target Therapy Combined with Gemox for Advanced Biliary Tract Cancers: a Meta-analysis based on RCTs

Cai, Wen; Yuan, Ying; Ge, Weiting; Fan, Yu; Liu, Xue; Wu, Dehao; Hu, Hanguang

doi:10.7150/jca.23290

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J Cancer 2018; 9(8):1476-1485. doi:10.7150/jca.23290 This issue Cite

Research Paper

EGFR Target Therapy Combined with Gemox for Advanced Biliary Tract Cancers: a Meta-analysis based on RCTs

Wen Cai^1,2, Ying Yuan¹, Weiting Ge², Yu Fan³, Xue Liu¹, Dehao Wu², Hanguang Hu^1,2✉

1. Department of Medical Oncology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
2. Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
3. Cancer Institute, the Affiliated People's Hospital of Jiangsu University, Jiangsu, Zhenjiang, China

Citation:

Cai W, Yuan Y, Ge W, Fan Y, Liu X, Wu D, Hu H. EGFR Target Therapy Combined with Gemox for Advanced Biliary Tract Cancers: a Meta-analysis based on RCTs. J Cancer 2018; 9(8):1476-1485. doi:10.7150/jca.23290. https://www.jcancer.org/v09p1476.htm

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Abstract

Background: Controversy exists regarding whether EGFR-targeted therapy combined with GEMOX (gemcitabine and oxaliplatin) provides additional benefits over GEMOX alone for biliary tract cancer patients. Therefore, this meta-analysis of randomized controlled trials (RCTs) was performed to assess the efficacy and safety of the GEMOX + EGFR-targeted regimen, and subgroup analysis was conducted to identify groups that might benefit from targeted therapy.

Methods: The PubMed, Cochrane Library, and ClinicalTrials.gov registries were searched for published studies. Hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were pooled using a fix-effect model. Risk-ratios (RRs) were used to analyse the objective response rate (ORR) and adverse events.

Results: Four RCTs were assessed. GEMOX + EGFR-targeted therapy significantly improved PFS (HR = 0.80, 95% CI 0.66-0.94, P = 0.03) and was associated with a better ORR (RR = 1.52, 95% CI 1.13-2.04, P = <0.01), whereas the TKI group achieved a better ORR in subgroup analysis. Patients with cholangiocarcinoma responded well to the GEMOX + EGFR-targeted regimen, leading to a better ORR (RR = 1.78, 95% CI 1.21-2.61, P = <0.01). Unfortunately, PFS benefits were not translated into OS benefits (HR = 0.92, 95% CI 0.75-1.08, P = 0.39).

Conclusion: GEMOX + EGFR-targeted therapy is a considerable and tolerable treatment option for patients with advanced BTCs, improving both PFS and ORR but not prolonging patient survival. Patients with cholangiocarcinoma would benefit the most from EGFR-targeted therapy.

Keywords: Biliary Tract Cancer, Meta-analysis, Gemcitabine, Oxaliplatin, Target therapy

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APA

Cai, W., Yuan, Y., Ge, W., Fan, Y., Liu, X., Wu, D., Hu, H. (2018). EGFR Target Therapy Combined with Gemox for Advanced Biliary Tract Cancers: a Meta-analysis based on RCTs. Journal of Cancer, 9(8), 1476-1485. https://doi.org/10.7150/jca.23290.

ACS

Cai, W.; Yuan, Y.; Ge, W.; Fan, Y.; Liu, X.; Wu, D.; Hu, H. EGFR Target Therapy Combined with Gemox for Advanced Biliary Tract Cancers: a Meta-analysis based on RCTs. J. Cancer 2018, 9 (8), 1476-1485. DOI: 10.7150/jca.23290.

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CSE

Cai W, Yuan Y, Ge W, Fan Y, Liu X, Wu D, Hu H. 2018. EGFR Target Therapy Combined with Gemox for Advanced Biliary Tract Cancers: a Meta-analysis based on RCTs. J Cancer. 9(8):1476-1485.

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