COMMENTARY

Cetuximab Continuation After CRC Progression May Up PFS

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

July 22, 2016

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Hello . I am David Kerr, professor of cancer medicine at University of Oxford. I just read an interesting Italian study published recently in the Annals of Oncology, led by a very good friend of mine, Fortunato Ciardiello,[1] who is currently the president of the European Society for Medical Oncology (ESMO) and somebody I worked with very closely for many years.

They were interested in looking at the continuation of cetuximab post-progression in colorectal cancer patients. They performed a multicentered study in 25 hospitals, and it was a randomized phase 2 trial. Initially, the study selected KRAS exon 2–positive patients who received FOLFIRI plus cetuximab; after progression, they were randomized to receive either FOLFOX alone or FOLFOX plus cetuximab.

The group went back subsequently and extended the RAS analysis to include additional KRAS and NRAS—full-on RAS testing, if you like, in 117 patients. Interestingly, in that group—what we would consider to be the modern treatment molecular subtypes for cetuximab— continuing with cetuximab post-progression in combination with FOLFOX increased progression-free survival from 5.3 to 6.9 months, which was statistically significant. There was a trend towards overall improved survival also.

As a randomized phase 2 trial, we do not read too much into it, but it paves the way very nicely, indeed, for subsequently proving this hypothesis in a larger randomized phase 3 trial. This is rather interesting and relevant data, given the debate about the positioning of chemotherapy plus epidermal growth factor receptor (EGFR) inhibitors as first-line treatment for metastatic and advanced colorectal cancer. At least it is a possibility that continuation of cetuximab post-progression in extended RAS 1-type patients may be beneficial.

We'll await the results of the phase 3 trials with interest. Thanks very much for listening. For the time being, Medscapers, ahoy and over and out. Thank you.

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