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

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Frontiers in Medicine Published June 3, 2026 Medically reviewed June 3, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider cetuximab maintenance for metastatic colorectal cancer; verify with future RCTs.

This systematic review and meta-analysis assessed the efficacy and safety of cetuximab maintenance therapy compared with observation in patients with metastatic colorectal cancer. The analysis included data from 727 patients. The primary outcomes were progression-free survival and overall survival. Secondary outcomes included all-grade and high-grade adverse effects.

Pooled results indicated a favorable effect on progression-free survival with a hazard ratio of 0.42 and a 95% confidence interval of 0.27 to 0.57 (P < 0.01). Overall survival was also prolonged with a hazard ratio of 0.47 and a 95% confidence interval of 0.19 to 0.74 (P < 0.01). A subgroup analysis suggested more survival benefit in Asian patients, with a hazard ratio of 0.53 and a 95% confidence interval of 0.15 to 0.60 (P = 0.010).

Regarding safety, diarrhea and rash were reported as more common. The relative risk for all-grade adverse effects revealed no statistical significance. Data on high-grade adverse effects were not reported. The authors note that subsequent large sample, multi-center randomized controlled trials are needed to further verify these conclusions.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

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.