Cetuximab maintenance therapy prolongs progression-free survival and overall survival versus observation in metastatic colorectal cancerCetuximab maintenance therapy extends survival in metastatic colorectal cancer

Backgroundmetastatic colorectal cancer (mCRC) represents a major global burden and the decision on whether to pursue maintenance with cetuximab (CET) remains controversial. Therefore, this meta-analysis was performed to assess the efficacy and safety of CET maintenance therapy.MethodsAfter literature search of PubMed, Embase, Cochrane Library and Scopus from inception to March 2026, two investigators selected eligible studies and extracted relevant data. The key outcomes were progression-free survival (PFS) and overall survival (OS). A random-effects model was used for pooling. The relative risks (RRs) with 95% confidence interval (CI) of all-grade and high-grade (≥3) adverse effects (AEs) were used to study its safety. Heterogeneity was also investigated through subgroup and sensitivity analysis.ResultsA total of 6 studies with 727 patients were included. CET maintenance therapy prolonged the PFS (HR: 0.42, 95% CI: 0.27 to 0.57, P < 0.01) and OS (HR: 0.47, 95% CI: 0.19 to 0.74, P < 0.01) of mCRC patients. Subgroup analysis showed that Asian patients (HR: 0.53, 95% CI: 0.15 to 0.60, P = 0.010) received more survival benefit from CET maintenance therapy than non-CET therapy or observation. Although diarrhea and rash were more common, the RR of all-grade AEs revealed no statistical significance.ConclusionCET maintenance therapy may be associated with improved outcomes compared with observation, especially in Asian patients. But it may slightly increase treatment-related toxicities. Therefore, subsequent large sample, multi-center randomized controlled trials (RCTs) are needed to further verify our conclusions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024513879, identifier CRD42024513879.