title: The role of cetuximab as first-line treatment of colorectal liver metastases.
abstract: BACKGROUND
  Recent advancements in the management of colorectal liver metastases have resulted in an improvement in survival. Novel biomarkers such as KRAS, and their mutations potentially predict the response of biological therapies such as cetuximab (Erbitux). This paper evaluates the use of cetuximab in the first-line management of colorectal liver metastases.
  
  
  METHODS
  An electronic literature search was performed of publications within the past 6 years. The following key words, singly or in combination, were used: KRAS, cetuximab, metastatic colorectal cancer and colorectal liver metastases. All randomized controlled trials and cohort studies were included.
  
  
  RESULTS
  Fifteen prospective studies reviewed the clinical application of cetuximab. Seven studies included sub-group analysis of KRAS mutational status, with only one study performed prospectively. Until the MRC COIN trial, the evidence consistently demonstrated cetuximab significantly improved progression-free survival, overall survival and surgical resection rates, especially in KRAS wild-type tumours. However, the MRC COIN trial found cetuximab had no additional benefit when combined with standard chemotherapy.
  
  
  CONCLUSIONS
  The literature does not support the routine use of cetuximab as the standard first-line treatment of colorectal liver metastases, rather highlighting the need for the optimization of treatment on an individual basis, especially depending on tumour KRAS status.
authors.affiliation: School of Medicine, Cardiff University, UK. cjones82@hotmail.co.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Jones
authors.forename: Mark A
authors.initials: MA
authors.lastname: Taylor
authors.forename: Billy
authors.initials: B
authors.lastname: McWilliams
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068818:Cetuximab; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000235:genetics / Q000473:pathology*; D018572:Disease-Free Survival; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D009154:Mutation; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D057285:Precision Medicine; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D018631:ras Proteins / Q000235:genetics
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins; D000068818:Cetuximab