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| Home > Publications database > Combination of oral fluoropyrimidines and EGFR-directed antibodies in frail patients with metastatic colorectal cancer: a systematic review. |
| Home > Publications database > Combination of oral fluoropyrimidines and EGFR-directed antibodies in frail patients with metastatic colorectal cancer: a systematic review. |
| Journal Article (Review Article) | DKFZ-2026-02604 |
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2026
Springer
Heidelberg
Abstract: Evidence of treatment strategies in frail patients (i.e. not fit for combination therapies) with unresectable metastatic colorectal cancer (mCRC) is limited to dose-reduced doublet regimens or oral fluoropyrimidines (FP) with bevacizumab. We conducted a systematic review analyzing evidence for oral FPs with epidermal growth factor receptor (EGFR)-directed monoclonal antibodies for patients with RAS wild-type (WT) mCRC across treatment lines.We searched PubMed and Cochrane Library for phase II and phase III studies evaluating oral FPs (capecitabine, S-1 or trifluridine/tipiracil (FTD/TPI)) plus EGFR-directed monoclonal antibody (panitumumab or cetuximab) in mCRC. Outcomes included efficacy and safety.Seven publications met inclusion criteria (n = 262 patients). First-line data was limited to elderly cohorts receiving capecitabine plus cetuximab or panitumumab with a median progression-free survival (PFS)/median overall survival (OS) of 7.2/17.1 months (cetuximab) and 7.5/23.7 months (panitumumab), respectively. In third-line and beyond, median PFS for the combination of FTD/TPI plus cetuximab or panitumumab ranged from 2.4 (cetuximab) to 5.8 months (panitumumab), and OS from 9.8 (cetuximab) to 14.2 months (panitumumab). S-1 plus cetuximab was associated with a median PFS of 5.5 months and OS of 13.6 months.While capecitabine should not be used together with anti-EGFR antibodies, FTD/TPI in combination with an EGFR-directed antibody appears feasible, shows promising activity and manageable toxicity profile in RAS WT mCRC potentially offering an alternative for frail patients; prospective trials are needed.
Keyword(s): Humans (MeSH) ; Colorectal Neoplasms: drug therapy (MeSH) ; Colorectal Neoplasms: pathology (MeSH) ; Antineoplastic Combined Chemotherapy Protocols: therapeutic use (MeSH) ; Antineoplastic Combined Chemotherapy Protocols: administration & dosage (MeSH) ; ErbB Receptors: antagonists & inhibitors (MeSH) ; Capecitabine: administration & dosage (MeSH) ; Administration, Oral (MeSH) ; Cetuximab: administration & dosage (MeSH) ; Trifluridine: administration & dosage (MeSH) ; Panitumumab: administration & dosage (MeSH) ; Drug Combinations (MeSH) ; Tegafur: administration & dosage (MeSH) ; Thymine: administration & dosage (MeSH) ; Frail Elderly (MeSH) ; Pyrrolidines: administration & dosage (MeSH) ; Neoplasm Metastasis (MeSH) ; Oxonic Acid: administration & dosage (MeSH) ; Antibodies, Monoclonal: administration & dosage (MeSH) ; Pyrimidines: administration & dosage (MeSH) ; EGFR-antibodies ; Frail ; Metastatic colorectal cancer ; Oral fluoropyrimidine ; ErbB Receptors ; EGFR protein, human ; Capecitabine ; Cetuximab ; Trifluridine ; Panitumumab ; Drug Combinations ; Tegafur ; Thymine ; Pyrrolidines ; trifluridine tipiracil drug combination ; Oxonic Acid ; S 1 (combination) ; Antibodies, Monoclonal ; Pyrimidines
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