The role of cetuximab as first-line treatment of colorectal liver metastases

Introduction Recent advancements in the management of colorectal liver metastases have resulted in an improvement in survival. Novel biomarkers such as KRAS, and their mutations potentially predict the response of biological therapies such as cetuximab (Erbitux). This paper evaluates the use of cetuximab in the first-line management of colorectal liver metastases. Methods An electronic literature search was performed of publications within the past 6 years. The following key words, singly or in combination, were used: KRAS, cetuximab, metastatic colorectal cancer and colorectal liver metastases. All randomized controlled trials and cohort studies were included. Results Fifteen prospective studies reviewed the clinical application of cetuximab. Seven studies included sub-group analysis of KRAS mutational status, with only one study performed prospectively. Until the MRC COIN trial, the evidence consistently demonstrated cetuximab significantly improved progression-free survival, overall survival and surgical resection rates, especially in KRAS wild-type tumours. However, the MRC COIN trial found cetuximab had no additional benefit when combined with standard chemotherapy. Conclusions The literature does not support the routine use of cetuximab as the standard first-line treatment of colorectal liver metastases, rather highlighting the need for the optimization of treatment on an individual basis, especially depending on tumour KRAS status