Cochrane · systematic review · CD007047
Epidermal growth factor receptor (EGFR) inhibitors for metastatic colorectal cancer
Chan, DLH, Segelov, E, Wong, RSH, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
ColorectalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
72
current version
GRADE rated
56
No studies
16
Included studies
NR
No studies 16 · 22.2%Ungraded 0 · 0%Very low 4 · 5.6%Low 14 · 19.4%Moderate 27 · 37.5%High 11 · 15.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
EGFR MAb in KRAS exon 2 WT for metastatic colorectal cancer
Population: people with metastatic colorectal cancer ‐ KRAS exon 2 WT
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | HR 0.7 [0.6, 0.82] | 12 studies · 4402 participants | High |
Overall survival | HR 0.88 [0.8, 0.98] | 12 studies · 4249 participants | High |
Tumour response rate | OR 2.41 [1.7, 3.41] | 12 studies · 4147 participants | High |
Overall grade 3 to 4 toxicity | OR 2.45 [2.07, 2.89] | 6 studies · 2771 participants | Moderate Downgraded: risk of bias |
Grade 3 to 4 diarrhoea | OR 1.84 [1.47, 2.32] | 7 studies · 2909 participants | Moderate Downgraded: risk of bias |
Grade 3 to 4 rash | OR 23.42 [13.22, 41.49] | 7 studies · 2909 participants | Moderate Downgraded: risk of bias |
Grade 3 to 4 neutropenia | OR 1.22 [0.93, 1.61] | 6 studies · 2666 participants | Moderate Downgraded: imprecision |
Quality of life | no estimate extracted | 5 studies · 2258 participants | Moderate Downgraded: risk of bias |
EGFR MAb in KRAS exon 2 MT for metastatic colorectal cancer
Population: people with metastatic colorectal cancer ‐ KRAS exon 2 MT
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | HR 1.03 [0.89, 1.2] | 8 studies · 2567 participants | Moderate Downgraded: inconsistency |
Overall survival | HR 1.03 [0.94, 1.13] | 8 studies · 2268 participants | High |
Tumour response rate | OR 0.93 [0.74, 1.16] | 8 studies · 1925 participants | High |
Overall grade 3 to 4 toxicity | OR 1.63 [0.98, 2.71] | 5 studies · 1635 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Grade 3 to 4 diarrhoea | OR 1.45 [1.01, 2.11] | 5 studies · 1635 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 rash | OR 32.35 [15.01, 69.7] | 5 studies · 1635 participants | Moderate Downgraded: risk of bias, imprecision |
Grade 3 to 4 neutropenia | OR 0.7 [0.53, 0.93] | 3 studies · 968 participants | High |
Quality of life | no estimate extracted | NR | No studies |
EGFR MAb in extended RAS WT for metastatic colorectal cancer
Population: people with metastatic colorectal cancer ‐ extended RAS WT
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | HR 0.6 [0.48, 0.75] | 6 studies · 1237 participants | Moderate Downgraded: inconsistency |
Overall survival | HR 0.77 [0.67, 0.88] | 4 studies · 1053 participants | High |
Tumour response rate | OR 4.28 [2.61, 7.03] | 4 studies · 1001 participants | Moderate Downgraded: inconsistency |
Overall grade 3 to 4 toxicity | no estimate extracted | NR | No studies |
Grade 3 to 4 diarrhoea | no estimate extracted | NR | No studies |
Grade 3 to 4 rash | no estimate extracted | NR | No studies |
Grade 3 to 4 neutropenia | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
EGFR MAb in extended RAS mutation for metastatic colorectal cancer
Population: people with metastatic colorectal cancer ‐ extended RAS MT
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | HR 1.13 [0.93, 1.36] | 6 studies · 2023 participants | Moderate Downgraded: inconsistency |
Overall survival | HR 1.09 [0.93, 1.28] | 4 studies · 1768 participants | Moderate Downgraded: inconsistency |
Tumour response rate | OR 0.76 [0.55, 1.05] | 3 studies · 840 participants | Moderate Downgraded: imprecision |
Overall grade 3 to 4 toxicity | no estimate extracted | NR | No studies |
Grade 3 to 4 diarrhoea | no estimate extracted | NR | No studies |
Grade 3 to 4 rash | no estimate extracted | NR | No studies |
Grade 3 to 4 neutropenia | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
EGFR inhibitors in KRAS unselected participants
Population: people with metastatic colorectal cancer, not selected by KRAS status
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | no estimate extracted | 2 studies · 1483 participants | High |
Overall survival | no estimate extracted | 2 studies · 1382 participants | High |
Tumour response rate | no estimate extracted | 2 studies · 1372 participants | Moderate Downgraded: imprecision |
Overall grade 3 to 4 toxicity | no estimate extracted | 1 study · 1267 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 diarrhoea | no estimate extracted | 2 studies · 1341 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 rash | no estimate extracted | 2 studies · 1341 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 neutropenia | no estimate extracted | 2 studies · 1341 participants | Moderate Downgraded: imprecision |
Quality of life | no estimate extracted | 1 study · 1298 participants | Moderate Downgraded: risk of bias |
Comparing EGFR inhibitors to another biologic agent
Population: people with metastatic colorectal cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | HR 1.02 [0.93, 1.12] | 4 studies · 2189 participants | High |
Overall survival | HR 0.84 [0.7, 1.01] | 4 studies · 2189 participants | Moderate Downgraded: imprecision, inconsistency |
Tumour response rate | OR 1.36 [1.15, 1.62] | 4 studies · 2184 participants | Moderate Downgraded: risk of bias |
Overall grade 3 to 4 toxicity | OR 1.37 [1.09, 1.72] | 4 studies · 2133 participants | Moderate Downgraded: risk of bias |
Grade 3 to 4 diarrhoea | OR 1.06 [0.67, 1.67] | 2 studies · 1673 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Grade 3 to 4 rash | OR 47.53 [14.84, 152.19] | 3 studies · 1951 participants | Moderate Downgraded: risk of bias, imprecision |
Grade 3 to 4 neutropenia | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Comparing different EGFR inhibitor agents or regimens
Population: people with metastatic colorectal cancer, not selected by KRAS status
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | no estimate extracted | 6 studies · 1651 participants | Moderate Downgraded: risk of bias |
Overall survival | no estimate extracted | 5 studies · 1482 participants | High |
Tumour response rate | no estimate extracted | 4 studies · 1313 participants | Moderate |
Overall grade 3 to 4 toxicity | no estimate extracted | 6 studies · 1651 participants | Moderate Downgraded: risk of bias |
Grade 3 to 4 diarrhoea | no estimate extracted | 6 studies · 1651 participants | Low Downgraded: risk of bias |
Grade 3 to 4 rash | no estimate extracted | 6 studies · 1651 participants | Low Downgraded: risk of bias |
Grade 3 to 4 neutropenia | no estimate extracted | 6 studies · 1651 participants | Moderate |
Quality of life | no estimate extracted | NR | No studies |
EGFR TKI in KRAS unselected participants
Population: people with metastatic colorectal cancer, not selected by KRAS status
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | no estimate extracted | 2 studies · 181 participants | Low Downgraded: risk of bias, imprecision |
Overall survival | no estimate extracted | 2 studies · 99 participants | Moderate Downgraded: imprecision |
Tumour response rate | no estimate extracted | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |
Overall grade 3 to 4 toxicity | no estimate extracted | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 diarrhoea | no estimate extracted | 2 studies · 181 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 rash | no estimate extracted | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |
Grade 3 to 4 neutropenia | no estimate extracted | 1 study · 99 participants | Moderate Downgraded: imprecision |
Quality of life | no estimate extracted | NR | No studies |
EGFR inhibitors added to bevacizumab for metastatic colorectal cancer
Population: people with metastatic colorectal cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression‐free survival | HR 1.04 [0.83, 1.29] | 6 studies · 1571 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Overall survival | HR 1 [0.69, 1.47] | 5 studies · 1257 participants | Low Downgraded: imprecision, inconsistency |
Tumour response rate | OR 1.2 [0.67, 2.12] | 4 studies · 1310 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Overall grade 3 to 4 toxicity | OR 2.57 [1.45, 4.57] | 3 studies · 1831 participants | Low Downgraded: risk of bias, inconsistency |
Grade 3 to 4 diarrhoea | OR 2.58 [1.44, 4.64] | 5 studies · 2434 participants | Low Downgraded: risk of bias, inconsistency |
Grade 3 to 4 rash | OR 67.52 [30.83, 147.85] | 4 studies · 2363 participants | Moderate Downgraded: risk of bias |
Grade 3 to 4 neutropenia | OR 0.97 [0.73, 1.29] | 2 studies · 1187 participants | Moderate Downgraded: imprecision |
Quality of life | no estimate extracted | NR | No studies |