patients with wild-type KRAS MCRC can benefit from Cetuximab or Bevacizumab With Combi Chemo Equivalent For patients with KRAS wild-type MCRC -
ESMO 16th World Congress on GI gastrointestinal cancer
for patients with wild-type KRAS untreated colorectal cancer, adding cetuximab or bevacizumab in combination chemotherapy provides equivalent survival, the researchers told the World Congress of ESMO 16 on the gastrointestinal cancer to Barcelona.
"the CALGB / SWOG 80405 trial was designed and formulated in 05, and the reason is simple: we got new --bevacizumab cetuximab-- and drugs and the study was designed to determine whether one was better than the other in the front line for patients with colon cancer, "said lead study author Alan P. Venook, distinguished professor of medical oncology and translational research at the University of California San Francisco, USA.
the CALGB trial 80405 / SWOG studied patients whose tumors were KRAS wild-type level codons 12 and 13 patients received FOLFIRI mFOLFOX6 or at the discretion of their physician and were randomized to cetuximab ( 578 patients) or bevacizumab (559 patients).
"There was no significant difference in outcomes between treatment arms," said Venook. "In both arms patients lived about 30 months. About 10% of patients lived more than 5 years. Patients Total did much better than expected and was indifferent to the type of treatment."
Because nearly 75% of the patients received chemotherapy mFOLFOX6, the interaction between experimental drugs and chemotherapy will be limited, but analysis is ongoing. Investigators also conduct molecular tests that can identify subsets of patients who did better or worse for each treatment.
Commenting on these data, ESMO spokesperson Dirk Arnold, director of the Department of Medical Oncology, Tumor Biology Center in Freiburg, Germany, said: "This was a highly anticipated Phase III trial with compared head-to-head in two different molecular approaches: the receptor for epidermal growth factor (EGFR) blocking cetuximab on one side and anti-angiogenic endothelial growth (anti-vascular factor [VEGF]) inhibiting bevacizumab treatment of other side, both in combination with a standard first-line chemotherapy in metastatic colorectal cancer. the trial is important because the primary endpoint was overall survival. FIRE-3 trial presented last year indicated that there may be an overall survival benefit with cetuximab but overall survival was only a secondary endpoint and data were inconclusive. "
" Each of the monoclonal antibodies in combination with standard chemotherapy, gave an overall survival of approximately 30 months: the longer overall survival in such a big test and clearly sets the standard " , Arnold continued. "We now know that the use of any monoclonal antibody with any standard chemotherapy in first-line treatment can give the patient the probability of survival of about 30 months. However, there is no clear winner in terms of overall survival. "
"Then we have to see the analyzes of cohort RAS pan. Then we need to know whether the various sub-groups benefit more from the anti-EGFR or anti-VEGF treatment. the type of chemotherapy or the location of the tumor may also play a role. "
as part of this test, the test results CRYSTAL now updated phase III and phase II OPUS trial show that adding cetuximab to FOLFIRI or FOLFOX4 in first-line treatment of metastatic colorectal cancer provides a greater benefit for patients with RAS wild-type tumors compared to the initial analysis with KRAS wild-type patients selected . Patients with tumor mutations RAS do not benefit
Commenting on these data, Dirk Arnold said .. "CRYSTAL and OPUS trials confirm the PRIME trial results of panitumumab and FOLFOX, another anti- EGFR These all mutations excluded trials in the KRAS gene and RNA and watched the anti-EGFR benefit in wild-type patients. three tests consistently show that EGFR and chemotherapy are better than chemotherapy alone. and EGFR in wild-type patients pan do better than the anti-EGFR in only patients exon 2 wild-type "
He added," the only issue raising questions is the fact that patients. who carry mutations may be at risk of adverse effect. therefore, genetic testing is not only a prerequisite to ensure maximum benefits, it is also necessary to ensure that we are doing a disservice by treating patients. "
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