title: Standard chemotherapy with cetuximab for treatment of colorectal cancer.
abstract: OBJECTIVE
  To review and assess the evidence related to cetuximab treatment in metastatic colorectal cancer (mCRC) with regard to KRAS status.
  
  
  METHODS
  PubMed, EMBASE, Cochrane database and American Society of Clinical Oncology meeting abstracts were searched for randomized controlled trials (RCTs) reporting the effect of KRAS status on efficacy of chemotherapy regimen with or without cetuximab in mCRC. Baseline information such as sex and age was summarized from the included studies. Hazard ratios of progression-free survival (PFS) and overall survival (OS) as well as objective response based on KRAS status were extracted for analysis.
  
  
  RESULTS
  A total of 8 RCTs with 6780 patients were included. The combined analysis showed that cetuximab failed to improve the OS and PFS in patients with mCRC. However, in subgroup analysis, the pooled data showed that addition of cetuximab to irinotecan containing chemotherapy regimen was sufficient to improve OS and PFS in wild-type KRAS mCRC patients, but not in patients with mutant-type KRAS. The addition of cetuximab increased the incidence of adverse events such as diarrhea, rash, skin toxicity/rash, and nausea and vomiting. There was no significant publication bias existing in the included studies.
  
  
  CONCLUSIONS
  The clinical benefit of cetuximab was only confirmed in patients with wild-type KRAS. KRAS status could be considered a biomarker of efficacy of cetuximab.
authors.affiliation: Xin-Xiang Li, Lei Liang, Li-Yong Huang, San-Jun Cai, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Xin-Xiang
authors.initials: XX
authors.lastname: Li
authors.affiliation: Xin-Xiang Li, Lei Liang, Li-Yong Huang, San-Jun Cai, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Liang
authors.affiliation: Xin-Xiang Li, Lei Liang, Li-Yong Huang, San-Jun Cai, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Li-Yong
authors.initials: LY
authors.lastname: Huang
authors.affiliation: Xin-Xiang Li, Lei Liang, Li-Yong Huang, San-Jun Cai, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: San-Jun
authors.initials: SJ
authors.lastname: Cai
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000068818:Cetuximab / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000378:metabolism; D006801:Humans; D058990:Molecular Targeted Therapy; D009154:Mutation; D016017:Odds Ratio; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C117307:KRAS protein, human; D047428:Protein Kinase Inhibitors; C512478:EGFR protein, human; D066246:ErbB Receptors; D016283:Proto-Oncogene Proteins p21(ras); D000068818:Cetuximab
keywords: Cetuximab; KRAS; Meta-analysis; Metastatic colorectal cancer; Standard chemotherapy