Anti-epidermal growth factor receptor therapy for advanced head and neck squamous cell carcinoma: a meta-analysis.
OBJECTIVE
To assess the efficacy and safety of anti-epidermal growth factor receptor (EGFR) therapy versus non-anti-EGFR therapy for advanced head and neck squamous cell carcinoma (HNSCC).


METHODS
The Cochrane Central Register of Controlled Trials, Medline, and Embase databases were searched for relevant reports. Quantitative analysis was carried out to evaluate the overall response rate (ORR), overall survival (OS), progression free survival (PFS), and grade 3-4 adverse effects.


RESULTS
Ten reports involving 2,396 patients were included. Primary meta-analysis indicated that anti-EGFR therapy could improve ORR [relative risk (RR) 1.36, 95% confidence interval (CI) 1.12-1.67] and PFS [hazard ratio (HR) 0.63, 95% CI 0.55-0.71), but failed to improve OS (HR 0.88, 95% CI 0.74-1.03). In subgroup analyses, we found that monoclonal antibodies (Mabs) could improve ORR, OS, and PFS for both locoregionally advanced (LA) (ORR: 1.21, 1.08-1.37; OS: 0.72, 0.59-0.89; PFS: 0.66, 0.53-0.83) and recurrent/metastatic (RM) HNSCC (ORR: 1.88, 1.40-2.54; OS: 0.79, 0.67-0.94; PFS: 0.61, 0.52-0.71), while tyrosine kinase inhibitors (TKIs) did not improve any of these in patients with either LA (ORR: 1.09, 0.91-1.32; OS: 0.7, 0.31-1.63; PFS: 0.71, 0.34-1.52) or RM (ORR: 1.65, 0.84-3.24; OS: 1.13, 0.97-1.31; PFS: not available) HNSCC. Analysis of adverse effects demonstrated that rash (RR 14.34, 95% CI 5.02-41.02), diarrhea (2.36, 1.15-4.87), and anorexia (2.49, 1.11-5.56) were significantly associated with anti-EGFR therapy.


CONCLUSIONS
Anti-EGFR Mabs are effective for both LA and RM HNSCC. In contrast, TKIs were unsuitable for treatment of advanced HNSCC. During anti-EGFR therapy, rash and some gastrointestinal reactions, such as diarrhea and anorexia, should be carefully monitored.
Department of Otorhinolaryngology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, People's Republic of China.
Shoude
S
Zhang
Jia
J
Chen
Hua
H
Jiang
Haina
H
Ma
Beibei
B
Yang
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D003875:Drug Eruptions / Q000209:etiology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D000077195:Squamous Cell Carcinoma of Head and Neck
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D066246:ErbB Receptors