International Journal of Clinical Oncology

, Volume 23, Issue 2, pp 389–399 | Cite as

Risk of fatigue in cancer patients receiving anti-EGFR monoclonal antibodies: results from a systematic review and meta-analysis of randomized controlled trial

  • Jianhong Zhu
  • Wenxia Zhao
  • Dan Liang
  • Guocheng Li
  • Kaifeng Qiu
  • Junyan Wu
  • Jianfang Li
Original Article



To evaluate the association between fatigue and anti-epidermal growth factor receptor monoclonal antibodies (anti-EGFR MAbs), we conducted the first meta-analysis to access the incidence and risk of fatigue associated with anti-EGFR MAbs.


Electronic databases were searched for randomized controlled trials (RCTs) published up to February 2017. Eligible studies were selected according to PRISMA statement. Incidence rates, risk ratio (RRs), and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models. Outcomes of quality were summarized in accordance with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.


Thirty-five RCTs (including 15,622 patients) were included; median follow-up ranged from 8.1 to 71.4 months, and the fatigue events were recorded and graded according to the Common Toxicity Criteria for Adverse Events version 2.0 or 3.0 in most of the included trials. For patients receiving anti-EGFR MAbs, the overall incidence of all-grade and high-grade fatigue was 54.1% and 10.5%, respectively. Compared with control, anti-EGFR MAbs significantly increased the risk of all-grade fatigue (RR 1.10, 95% CI, 1.05–1.14, moderate-quality evidence) and high-grade fatigue (RR 1.31, 95% CI, 1.19–1.45, moderate-quality evidence). No significant differences among subgroup analyses (anti-EGFR MAbs, tumor type, and median follow-up) on high-grade fatigue were observed. No evidence of publication bias was observed.


The present study suggested that anti-EGFR MAbs may increase the risk of fatigue in cancer patients.


Anti-EGFR MAbs Fatigue Meta-analysis 



This work was supported by Grant [2013]163 from Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology; Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes. The sponsors have no role in the design or implementation of the study, data collection, data management, data analysis, data interpretation, or in the preparation, review, or approval of the manuscript.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflicts of interest.

Supplementary material

10147_2017_1218_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 kb)
10147_2017_1218_MOESM2_ESM.pdf (22 kb)
Supplementary material 2 (PDF 22 kb)


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  1. 1.Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationSun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of PharmacySun-Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhouPeople’s Republic of China

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