Summary

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• Erbitux (cetuximab) is indicated for the treatment of locally or regionally advanced squamous cell carcinoma of the head and neck in combination with radiation therapy; the treatment of recurrent locoregional disease or metastatic squamous cell carcinoma of the head and neck in combination with platinum-based therapy with fluorouracil; the treatment of recurrent or metastatic squamous cell carcinoma of the head and neck progressing after platinum-based therapy; the treatment of K-Ras wild-type, EGFR-expressing, metastatic colorectal cancer as determined by an FDA-approved test: in combination with FOLFIRI for first-line treatment, in combination with irinotecan in patients who are refractory to irinotecan-based chemotherapy, as a single-agent in patients who have failed oxaliplatin- and irinotecan-based chemotherapy or who are intolerant to irinotecan; and the treatment of BRAF V600E mutation-positive metastatic colorectal cancer (CRC) in combination with encorafenib for the treatment of adult patients with metastatic colorectal cancer (CRC) with a BRAF V600E mutation, as detected by an FDA-approved test, after prior therapy.
• This summary is based on the review of 10 systematic review(s)/meta-analysis(es). ^[1-10]
• Metastatic Colorectal Cancer (mCRC): The combination of FOLFOXIRI and cetuximab improved the objective response rate (ORR) to 85% and the R0 resection rate to 42%, with median progression-free survival (PFS) ranging from 9.5 to 15.5 months, and median overall survival (OS) from 24.7 to 37 months. High ORR (82%) and R0 resection rate (59%) were also observed with triplet chemotherapy and anti-EGFR therapy, with median PFS between 9.5 and 17.8 months, and OS between 24.7 and 62.5 months.
• Head and Neck Squamous Cell Carcinoma (HNSCC): Cetuximab with radiotherapy (ExRT) showed less favorable outcomes in overall survival (OS), disease-specific survival (DSS), locoregional control (LRC), and progression-free survival (PFS) compared to platinum-based chemotherapy with radiotherapy (ChRT). Concurrent cisplatin with radiotherapy (CRT) provided better OS, PFS, LRC, and distant metastasis-free survival (DMFS) compared to cetuximab with radiotherapy (BRT).
• Non-Small Cell Lung Cancer (NSCLC): EGFR-targeted therapies (erlotinib, gefitinib, afatinib, and icotinib) demonstrated increased tumor response rates and prolonged PFS compared to cytotoxic chemotherapy in EGFR mutation-positive NSCLC patients.
• Diarrhea and neutropenia were the most common grade 3 and 4 adverse events in patients with metastatic colorectal cancer (mCRC) treated with the FOLFOXIRI + anti-EGFR antibody regimen.
• Cetuximab-based chemotherapy in mCRC increased the risk of dermatological (e.g., rash) and renal adverse events, while bevacizumab-based chemotherapy was associated with a higher risk of cardiovascular events such as hypertension and arrhythmia.
• In patients with head and neck squamous cell carcinoma (HNSCC), cetuximab combined with radiotherapy (ExRT) resulted in higher rates of mucositis, skin toxicity, and infection compared to platinum-based chemotherapy with radiotherapy (ChRT), but lower incidence of anemia, leukocytopenia, neutropenia, nausea/vomiting, and renal toxicity.
• Studies focused on molecularly unselected and unresectable metastatic CRC patients, with specific subgroup considerations for RAS wild-type mCRC, human papillomavirus-positive locally advanced HNSCC, and predominantly Asian EGFR mutation-positive NSCLC patients, revealing different safety profiles for bevacizumab and cetuximab-based chemotherapy in RAS wild-type mCRC, inferior disease-specific survival and locoregional control for ExRT compared to ChRT in HPV-positive HNSCC, and increased progression-free survival and tumor response rates for EGFR-targeted therapies in EGFR mutation-positive NSCLC.