Cetuximab or Nimotuzumab Versus Cisplatin Concurrent with Radiotherapy for Local-Regionally Advanced Nasopharyngeal Carcinoma: a Meta-analysis

Abstract

Background: It is unclear whether Cetuximab (CTX) or Nimotuzumab (NTZ) concurrent with radiotherapy delivers<br />equivalent or improved results with fewer toxicities over standard cisplatin (CDDP) concurrent with radiotherapy<br />in locally advanced nasopharyngeal carcinoma (NPC). Methods: The strategy involved searching the PubMed,<br />Embase, Cochrane Library, China National Knowledge Internet Web, Wanfang and Chinese Biomedical databases.<br />Controlled clinical trials that compared concurrent CTX/NTZ with radiotherapy versus CDDP with radiotherapy<br />in local-regionally advanced NPC were included. Results: In all, 1,239 patients in six clinical trials were included<br />in the analysis. The hazard ratios (HRs) between the CTX/NTZ and CDDP groups were 1.01 (95% confidence interval<br />(CI) 0.63-1.64), 1.06 (95% CI 0.50-2.25), 1.04 (95% CI 0.61-1.76), and 1.05 (95% CI 0.73-1.50) for overall survival,<br />local-regional failure-free survival, distant metastasis failure-free survival, and disease-free survival, respectively.<br />Significant differences were found in the incidences of grade 3-4 anaemia [Risk ratio (RR) 0.11 95% CI 0.02-0.58], grade<br />3-4 neutropenia (RR 0.23 95% CI 0.12- 0.44), grade 3-4 thrombocytopenia (RR 0.31 95% CI 0.12- 0.79), and grade<br />3-4 vomiting (RR 0.04 95% CI 0.00-0.29) in favour of the CTX/NTZ group. However, the patients in the CTX/NTZ<br />group experienced a higher incidence of grade 3-4 skin rash (RR 6.45 95% CI 3.84-10.84). Conclusions: Regarding<br />the efficacy and side effects, the combination of CTX / NTZ and radiotherapy may be an alterative treatment regimen<br />of standard CDDP concurrent with radiotherapy in local-regionally advanced NPC, especially in patients who cannot<br />tolerate or who refuse chemotherapy.