Combination of oral fluoropyrimidines and EGFR-directed antibodies in frail patients with metastatic colorectal cancer: a systematic review.
Alena Annbalou Hasenburg, Sebastian Stintzing, Arndt Stahler
✦ AI-curated · Sources linked
In 30 seconds
This systematic review assessed phase II and III evidence for oral fluoropyrimidines combined with EGFR-directed antibodies in patients with RAS wild-type metastatic colorectal cancer, including those considered unfit for combination therapy. Seven publications involving 262 patients were included. In later treatment lines, trifluridine/tipiracil plus an EGFR antibody was associated with median progression-free survival ranging from 2.4 months with cetuximab to 5.8 months with panitumumab, and median overall survival from 9.8 to 14.2 months. The authors considered this combination feasible, with promising activity and manageable toxicity, while calling for prospective trials.
Key findings
- Seven publications covering 262 patients met the review criteria.
- In third-line and later treatment, trifluridine/tipiracil plus cetuximab or panitumumab had median progression-free survival of 2.4 to 5.8 months and overall survival of 9.8 to 14.2 months.
- For S-1 plus cetuximab, median progression-free survival was 5.5 months and median overall survival was 13.6 months.
- The review concludes that capecitabine should not be combined with anti-EGFR antibodies.
Why it matters
Treatment evidence for frail patients with metastatic colorectal cancer is limited, and this review identifies a potential oral regimen paired with EGFR-directed therapy for RAS wild-type disease. Its findings help frame the available evidence across treatment lines, while the small evidence base and need for prospective trials mean the reported activity should be interpreted cautiously.
What to keep in mind
Only seven publications and 262 patients were included; the review reports limited first-line data and concludes that prospective trials are needed.