The Efficacy and Safety of Anti-epidermal Growth Factor Receptor Monoclonal Antibodies in Nasopharyngeal Carcinoma: Literature-based Meta-analyses

Abstract

Background: Anti-epidermal growth factor receptor monoclonal antibodies (anti-EGFR mAbs), such as cetuximab and nimotuzumab have been used in the treatment of nasopharyngeal carcinoma (NPC), yet their efficacy and safety are undetermined.Materials and Methods: We performed two meta-analyses based on systematic searches of PubMed, EMBASE, the Cochrane Library and SinoMed: comparison 1 (standard therapy plus mAbs vs. standard therapy) and comparison 2 (radiotherapy plus concurrent mAbs vs. concurrent chemoradiotherapy) to explore the treatment value of anti-EGFR mAbs in NPC. Primary outcomes were overall survival (OS) and disease-free survival (DFS); secondary outcomes, locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and grade 3 and above acute adverse events.Results: Four randomized controlled trials and thirteen observational studies were eligible. Comparison 1 (twelve studies): adding mAbs to standard therapy (radiotherapy or chemoradiotherapy) significantly improved OS (HR, 0.51; 95% CI, 0.39-0.66) and DFS (HR, 0.68; 95% CI, 0.54-0.86), but increased the frequency of skin rashes and mucositis. Comparison 2 (six studies): OS (HR, 1.17; 95% CI, 0.81-1.70) and DFS (HR, 1.16; 95% CI, 0.86-1.57) were not significantly different when mAbs replaced conventional cytotoxic chemotherapy concurrently with radiotherapy, with fewer hematological, gastrointestinal and renal toxicities and more skin rashes in the mAb group.Conclusion: We recommend anti-EGFR mAbs enhance—but should not replace—current treatment paradigms for locoregionally advanced NPC. Further evidence from phase III clinical trials is required.

EGFR-PKM2 signaling promotes the metastatic potential of nasopharyngeal carcinoma through induction of FOSL1 and ANTXR2

“…For patients with extremely high levels of EGFR, in whom the metastasis cannot be imaged, more active systemic treatments or preventive treatments should be considered. A recent meta-analysis demonstrated that anti-EGFR monoclonal antibody treatment combined with radiotherapy or chemoradiotherapy significantly improved OS and DFS in NPC patients ( 44 ) with tolerable side effects. This suggests that locoregionally advanced NPC would likely benefit from anti-EGFR monoclonal antibody treatment.…”

Tumour heterogeneity and intercellular networks of nasopharyngeal carcinoma at single cell resolution

“…It would be plausible that disrupting the interactions might break the balance of TME and thus cure the tumour. Besides the promising results of PD-1/PD-L1 blockade immunotherapy in NPC, antibodies targeting EGFR have been reported to enhance the current treatment paradigms for locoregionally advanced NPC 64 . We suspect that immune-suppressive interaction of CD200-CD200R1 and LGALS9-HAVCR2 among LAMP3 + DCs, Treg cells, and exhausted CD8 + T cells might be also potential immunotherapeutic targets for NPC.…”

Effectiveness and cost-effectiveness analysis of nimotuzumab for the radiotherapy of locoregionally advanced nasopharyngeal carcinoma

“…Although there is no clear consensus, most studies suggest that anti-EGFR monoclonal antibodies, especially nimotuzumab and cetuximab, confer significant benefits in patients with LA-NPC. According to a meta-analysis, addition of anti-EGFR monoclonal antibodies to standard therapy for NPC significantly improved OS (HR, 0.51; 95% CI, 0.39-0.66) compared to standard therapy alone [25]. In a case-control study based on intelligence platform, concurrent administration of nimotuzumab/ cetuximab with IC was found to be more effective, with a significant improvement in 3-year disease-free survival rate (84.3% vs. 74.3% P = 0.027) [9].…”