Page 27 - ARNM-3-1

Advances in Radiotherapy
& Nuclear Medicine Chinese Expert Consensus for LACC

Table 1. Grading of evidence quality and consensus 3.1.3. Combination therapy involving anti-epidermal
recommendation strength growth factor receptor (EGFR) antibodies
Evidence level Definition EGFR monoclonal antibodies suppress the malignant
Evidence quality grade biological behaviors of tumor cells by recognizing the
High Future research is unlikely to significantly change the extracellular segment of the EGFR receptor and competing
credibility of existing efficacy evaluations with the ligand for binding. This action involves blocking
Medium Future research may have a significant effect on the ligand binding site of EGFR, disrupting receptor
existing efficacy evaluations, potentially altering the phosphorylation, impeding activation, and inhibiting the
credibility of the results signaling pathway. Cetuximab and nimotuzumab are two
Low Future research is likely to have a significant effect on frequently employed pharmaceuticals targeting EGFR.
existing efficacy evaluations, with a higher likelihood Cetuximab is a human-mouse chimeric anti-EGFR
of changing the credibility of the results
monoclonal antibody that competitively interacts with
Very low Evaluation of any efficacy is highly uncertain
EGFR to inhibit tumor cell growth by impeding intracellular
Consensus recommendation grade proliferative signals. It can be utilized for the treatment of
Strong Clearly indicates that the benefits of the intervention head and neck squamous cell carcinoma and metastatic
outweigh the harms or vice versa colorectal cancer. Research investigating the efficacy of
Weak Uncertainty in the balance of benefits and harms or cetuximab in treating LACC is ongoing. In a Phase II
evidence, regardless of its quality, shows a balance randomized controlled study involving 78 participants
between benefits and harms
with a median 31-month follow-up, a combination of
cetuximab with CCRT for LACC revealed 2-year DFS rate
• Level of evidence: Low of 63% (95% confidence interval [CI], 49 – 80%) compared
• Grade of recommendation: Weak. with 76% (95% CI, 63 – 91%) in the control group, with
non-significant between-group differences (P = 0.18).
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3.1.2. Combination therapy involving recombinant The experimental group exhibited a 2-year OS rate of 83%
human vascular endothelial inhibitors
(95% CI, 72 – 96%), appearing similar to 87% (95% CI,
Recombinant human vascular endothelial inhibitor 76 – 98%) in the control group. Both groups exhibited
impedes the migration of vascular endothelial cells, comparable safety profiles, and no grade ≥3 adverse events
thereby preventing tumor neoangiogenesis and cutting off occurred.
the nutrient supply to the tumor, which hinders its growth In 2022, a Phase I feasibility study was conducted,
and metastasis. For example, Endostar, primarily used for involving 21 participants who received varying cetuximab
treating advanced non-small cell lung cancer (NSCLC), doses (250 or 200 mg/m ) in combination with CCRT
2
has been recently utilized in managing LACC treatment. In (cisplatin, 30 or 40 mg/m ). The study reported 5-year
2 12
a Phase II randomized controlled trial (n = 116), the trial PFS and OS rates of 57.5% and 58.5%, respectively.
group exhibited 1- and 2-year progression-free survival Notably, when administering cetuximab at 250 mg/m
2
(PFS) rates of 91.4% and 80.8%, respectively, surpassing combined with CCRT (cisplatin, 30 mg/m ), only one
2
those of the control group at 82.1% and 63.5%, respectively; patient was diagnosed with dose-limiting toxicity (DLT,
however, the difference was not significant (P = 0.091). Both grade 4 renal failure), and other patients demonstrated
groups demonstrated analogous safety profiles. Another tolerability. However, the study primarily concentrated
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randomized controlled trial revealed a higher complete on toxicology and provided limited evidence of efficacy;
response rate (CRR) in the experimental group (83% vs. thus, cetuximab has not been recommended for treating
65%, P < 0.05), with no significant differences in objective patients with LACC.
response rate (ORR) or disease control rate (DCR) (93% vs. • Level of evidence: Low (cetuximab)
90% and 95% vs. 95%; P > 0.05) compared with the control • Grade of recommendation: Weak (cetuximab).
group. The experimental group experienced higher Nimotuzumab is utilized for treating stage III/IV
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frequencies of infections (50% vs. 18%), hypertension nasopharyngeal carcinoma that expresses EGFR, and
(16% vs. 2%), and neutropenia (68% vs. 44%). Despite the Phase III studies on LACC are ongoing. Patients diagnosed
limited sample size, low evidence level, and lack of long- with LACC receive nimotuzumab, and measuring EGFR
term follow-up data (e.g., 3-year PFS and OS), patients expression is recommended in facilities where available.
may be advised to consider participation in clinical trials. No discernible variations in efficacy and safety based on
• Level of evidence: Low pathology type were observed. The trial group receiving
• Grade of recommendation: Weak. nituzumab with CCRT comprised 147 participants,

Volume 3 Issue 1 (2025) 19 doi: 10.36922/arnm.4032