Treatment patterns and outcomes of acneiform eruptions from anti-epidermal growth factor receptor (EGFR) therapies for metastatic colorectal cancer (MCRC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 668-668
Author(s):  
Bogdan Dascalu ◽  
Hagen F. Kennecke ◽  
Howard John Lim ◽  
Winson Y. Cheung
Keyword(s):  
Overall Survival ◽  
Prophylactic Treatment ◽  
Cox Regression ◽  
Growth Factor Receptor ◽  
Median Number ◽  
Treatment Patterns ◽  
Wild Type ◽  
Type K ◽  
Number Of Treatment ◽  
Rash Management

668 Background: Use of anti-EGFR therapies, such as cetuximab (cmab) and panitumumab (pmab), is associated with acneiform eruptions. Because prior research suggests a possible correlation between rash severity and outcomes in unselected patients, concerns remain that prophylactic treatment of rash may interfere with anti-tumor activities of these drugs. Our aims were to: 1) characterize the treatment patterns for rashes due to cmab and pmab; and 2) evaluate if a prophylactic vs. reactive approach to rash management modifies outcomes. Methods: All patients diagnosed with wild-type K-ras MCRC from July 2009 to June 2011 in British Columbia, Canada and prescribed either cmab or pmab were identified. We conducted a detailed retrospective review to describe prophylactic (before rash) and reactive (after rash) use of antibiotics and steroid creams. Using Cox regression, the relationship between rash management and overall survival was characterized. Results: In total, 78 eligible patients were analyzed: median age was 62 years, 65% were male, 27% received cmab and 73% pmab, and median number of anti-EGFR treatment was 9 cycles. Rash occurred in 88% of patients. Among them, reactive treatment was favored over prophylactic treatment (74% vs. 26%). There were no differences in rash management based on any patient or tumor characteristics (all p>0.05). Median overall survival was 7.2 months. The number of treatment cycles and overall survival were similar in both prophylactic and reactive groups. In Cox regression, ECOG 2+ correlated with worse overall survival (HR for death 5.95, 95% CI 1.68- 21.13). However, outcomes were statistically similar between patients prescribed antibiotics prophylactically vs. reactively (HR=1.47, 95% CI 0.37-5.90) and between patients given steroid creams prophylactically vs. reactively (HR=0.75, 95% CI 0.11-4.88). Conclusions: Prophylactic treatment of anti-EGFR related rash is associated with similar outcomes as reactive rash treatment in wild-type K-ras MCRC patients. Because rash can lead to decreased quality of life, pre-emptive skin treatment represents a reasonable strategy for patients on anti-EGFR therapies.

Treatment patterns and outcomes of acneiform skin eruptions from anti-epidermal growth factor receptor (EGFR) therapies for metastatic colorectal cancer (mCRC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19547-e19547
Author(s):  
Bogdan Dascalu ◽  
Hagen F. Kennecke ◽  
Howard John Lim ◽  
Winson Y. Cheung
Keyword(s):  
Overall Survival ◽  
Prophylactic Treatment ◽  
Cox Regression ◽  
Growth Factor Receptor ◽  
Median Number ◽  
Treatment Patterns ◽  
Reactive Groups ◽  
Epidermal Growth ◽  
Number Of Treatment ◽  
Rash Management

e19547 Background: Use of anti-EGFR therapies, such as cetuximab (Cmab) and panitumumab (Pmab), is associated with acneiform eruptions. Because research suggests a correlation between rash severity and outcomes in unselected patients, concerns remain that prophylactic treatment of rash may interfere with anti-tumor activities of these drugs. Our aims were to 1) characterize the treatment patterns for rash due to Cmab and Pmab and 2) evaluate if a prophylactic vs reactive approach to rash management modifies outcomes. Methods: All patients diagnosed with wild-type K-ras mCRC from July 2009 to June 2011 in British Columbia, Canada and prescribed either Cmab or Pmab were reviewed to describe patterns of prophylactic (before rash) and reactive (after rash) use of antibiotics and steroid creams. Using Cox regression, the relationship between rash management and overall survival was characterized. Results: In total, 119 patients were analyzed: median age at diagnosis was 63 years, 61% were men, 34% received Cmab and 66% Pmab, and median number of anti-EGFR treatment was 9 cycles. Rash occurred in over 90% of patients. Among them, reactive was favored over prophylactic treatment (66 vs 34%). Older patients (60+ years) and those with ECOG 0/1 were more likely to receive prophylactic creams (44 vs 20%, p=0.01) and antibiotics (62 vs 12%, p=0.01), respectively. There were no further differences in rash management based on other patient or tumor characteristics (all p>0.05). Median OS was 7.0 months. The number of treatment cycles and overall survival were similar in both prophylactic and reactive groups (both p>0.05). In Cox regression, ECOG 2+ correlated with worse survival than ECOG 0/1 (HR for death 5.25 95% CI 2.01- 9.23, p<0.01). However, survival outcomes were statistically similar between patients prescribed antibiotics prophylactically vs. reactively (HR=1.10, 95% CI 0.43-2.80, p=0.85) and between patients given steroid creams prophylactically vs. reactively (HR=2.00, 95% CI 0.58-6.92, p=0.27). Conclusions: Prophylactic treatment of anti-EGFR related rash is associated with similar outcomes as compared to reactive rash treatment in mCRC patients.

A National Cancer Database analysis of the patterns of care for meningeal melanocytoma

2021 ◽  
Author(s):  
Amanda C Tep ◽  
Patrick D Kelly ◽  
Daphne B Scarpelli ◽  
Bailey Bergue ◽  
Shearwood McClelland III ◽  
...  
Keyword(s):  
Overall Survival ◽  
Patient Outcomes ◽  
Cox Regression ◽  
Treatment Patterns ◽  
National Cancer Database ◽  
Regression Analyses ◽  
Database Analysis ◽  
Meningeal Melanocytoma ◽  
Kaplan Meier ◽  
Poor Treatment

Aim: To evaluate demographics, treatment patterns, radiotherapy utilization and patient outcomes in meningeal melanocytomas. Materials & methods: The National Cancer Database was queried for meningeal melanocytomas diagnosed in 2002–2016. The effects of demographic, clinical and treatment variables were determined via Kaplan–Meier log-rank and Cox regression analyses. Results: The median and 5-year overall survival were 57.46 months and 48%, respectively. Patients earning ≥ $48K showed improved survival (p = 0.0319). Radiotherapy and chemotherapy were utilized in 37.7 and 9% of patients, respectively. Conclusion: Income significantly affected survival. Surgery remains the mainstay approach. Radiotherapy was delivered in more than one-third of patients but did not impact survival. However, further analyses were limited by poor treatment modality information in the database.

Amphiregulin (AR) expression in the prediction of benefit from cetuximab plus irinotecan in KRAS wild-type metastatic colorectal cancer (mCRC) patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4021-4021
Author(s):  
F. Loupakis ◽  
C. Cremolini ◽  
G. Perrone ◽  
I. Stasi ◽  
L. Salvatore ◽  
...  
Keyword(s):  
Growth Factor Receptor ◽  
Median Number ◽  
Prognostic Impact ◽  
Wild Type ◽  
Primary Tumors ◽  
Tissue Sections ◽  
Mutational Status ◽  
Epidermal Growth ◽  
Score Range

4021 Background: AR is an endogenous ligand of Epidermal Growth Factor Receptor (EGFR), whose binding is prevented in the presence of cetuximab. Methods: We retrospectively assessed KRAS mutational status and AR expression at immunohistochemistry (IHC) in 86 irinotecan-refractory EGFR-positive mCRC patients treated with cetuximab plus irinotecan. AR-IHC was performed on tissue sections from paraffin-embedded primary tumors. Specimens were defined AR-low or AR-high according to a score (range 0–300) obtained multiplying intensity (0 to 3+) by percentage of stained cells (0–100%). According to the results of a ROC analysis, we identified a cut-off value of 18. The association between AR-IHC and treatment outcome in terms of response rate (RR), PFS, and OS was investigated in the subgroup of KRAS wild-type patients. Results: Eighty-six consecutive patients were included. M/F = 44/42, median age = 67 (41–78), median number of previous lines of chemotherapy = 2 (1–5). Among 51 (59%) KRAS wild-type patients, 12 PRs and 1 CR were observed, for an overall RR of 25% (13/51). AR-IHC was high, low or unconclusive in 27, 22 and 2 cases respectively. AR-low patients reported a significantly worse RR (2/22, 9%) compared with AR-high (10/27, 37%) (p = 0.024) and a trend toward shorter PFS (3.5 vs 5.3 months, HR 0.88 [95%CI: 0.46–1.60], p = 0.628) and OS (8.8 vs 15.1 months, HR 0.60 [95%CI: 0.30–1.10], p = 0.106). Conclusions: These results underline the potential role of endogenous ligands in influencing the activity of anti-EGFR monoclonal antibodies. Absent or low AR expression at IHC may be related to resistance to cetuximab plus irinotecan. Further data regarding the prognostic impact of AR expression are needed. No significant financial relationships to disclose.

Epidermal growth factor receptor mutation status and adjuvant chemotherapy in resected advanced non-small cell lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7034-7034 ◽  
Author(s):  
Si-Yu Wang ◽  
Haibo Sun ◽  
Wei Ou ◽  
Qin Fang
Keyword(s):  
Overall Survival ◽  
Epidermal Growth Factor Receptor ◽  
Adjuvant Chemotherapy ◽  
Growth Factor Receptor ◽  
Disease Free Survival ◽  
Egfr Mutations ◽  
Wild Type ◽  
Free Survival ◽  
Epidermal Growth ◽  
Disease Free

7034 Background: Mutations in the epidermal growth factor receptor (EGFR) are associated with response to chemotherapy in patients with advance NSCLC. The purpose of this study was to assess the association of mutations in the EGFR tyrosine kinase domain and the efficacy of adjuvant chemotherapy in patients with fully resected IIIA-N2 NSCLC tumors. Methods: Tumor samples (n =150) from patients in our prior trial with IIIA-N2 NSCLC who either had or had not received paclitaxel/vinorelbine plus carboplatin chemotherapy following removal of the tumor were analyzed for EGFR mutations in exons 19 and 21. The association of the presence of EGFR mutations and survival following treatment was assessed. Results: Mutations were identified in 33 (22%) patients (n=13 in the no chemotherapy [observation] arm and n=20 in the chemotherapy arm). Fourteen patients (9.3%) had deletion mutations in exon 19, and 19 patients (12.7%) had a substitution mutation in exon 21. Compared with patients wild-type for EGFR, patients with EGFR mutations had numerical but not statistically significant improved disease-free survival (35 months [95% CI, 14.6-55.4] versus 23 months [95% CI, 17.3-28.7], respectively, P=0.339) and overall survival (36 months [95% CI, 27.9 to 44.1] versus 26 months [95% CI, 20.1 to 31.9], respectively p=0.271) regardless of treatment. Patients with wild-type EGFR had greater overall survival with chemotherapy compared to no adjuvant therapy (HR=1.920; 95%CI, 1.245-2.963; p=0.003). In contrast, EGFR mutant patients in the observation group compared to the chemotherapy group had longer median disease-free survival (35 months [95% CI, 20.9 to 49.1] versus 27 months [95% CI, 5.3 to 48.7], respectively, p=0.671) and overall survival (33 months [95% CI, 24.2 to 41.8] versus 40 months [95% CI, 31.8 to 48.2] respectively, p =0.360). Conclusions: In this study, the status of mutations in exons 19 and 21 of EGFR was associated with different clinical outcomes in patients with resected IIIA-N2 NSCLC tumors either treated with or without adjuvant chemotherapy. These findings suggest that a patient’s treatment should be customized to their EGFR mutational status.

Phase III Randomized, Placebo-Controlled Study of Cetuximab Plus Brivanib Alaninate Versus Cetuximab Plus Placebo in Patients With Metastatic, Chemotherapy-Refractory, Wild-Type K-RAS Colorectal Carcinoma: The NCIC Clinical Trials Group and AGITG CO.20 Trial

2013 ◽  
Vol 31 (19) ◽  
pp. 2477-2484 ◽  
Author(s):  
Lillian L. Siu ◽  
Jeremy D. Shapiro ◽  
Derek J. Jonker ◽  
Chris S. Karapetis ◽  
John R. Zalcberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Growth Factor ◽  
Objective Response ◽  
Growth Factor Receptor ◽  
Dose Intensity ◽  
Phase Iii ◽  
Controlled Study ◽  
Wild Type ◽  
Positive Effects ◽  
Type K

Purpose The antiepidermal growth factor receptor monoclonal antibody cetuximab has improved survival in patients with metastatic, chemotherapy-refractory, wild-type K-RAS colorectal cancer. The addition of brivanib, a tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor and fibroblast growth factor receptor, to cetuximab has shown encouraging early clinical activity. Patients and Methods Patients with metastatic colorectal cancer previously treated with combination chemotherapy were randomly assigned 1:1 to receive cetuximab 400 mg/m2 intravenous loading dose followed by weekly maintenance of 250 mg/m2 plus either brivanib 800 mg orally daily (arm A) or placebo (arm B). The primary end point was overall survival (OS). Results A total of 750 patients were randomly assigned (376 in arm A and 374 in arm B). Median OS in the intent-to-treat population was 8.8 months in arm A and 8.1 months in arm B (hazard ratio [HR], 0.88; 95% CI, 0.74 to 1.03; P = .12). Median progression-free survival (PFS) was 5.0 months in arm A and 3.4 months in arm B (HR, 0.72; 95% CI, 0.62 to 0.84; P < .001). Partial responses observed (13.6% v 7.2%; P = .004) were higher in arm A. Incidence of any grade ≥ 3 adverse events was 78% in arm A and 53% in arm B. Fewer patients received ≥ 90% dose-intensity of both cetuximab (57% v 83%) and brivanib/placebo (48% v 87%) in arm A versus arm B, respectively. Conclusion Despite positive effects on PFS and objective response, cetuximab plus brivanib increased toxicity and did not significantly improve OS in patients with metastatic, chemotherapy-refractory, wild-type K-RAS colorectal cancer.

A phase III trial (ZJBIO009): CMAB009 plus irinotecan versus irinotecan alone as second-line treatment after fluoropyrimidine and oxaliplatin failure in wild-type K-ras metastatic colorectal cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3513-3513
Author(s):  
Yuankai Shi ◽  
Jin Li ◽  
Jianming Xu ◽  
Ying Cheng ◽  
Wei Liu ◽  
...  
Keyword(s):  
Growth Factor Receptor ◽  
Phase Iii ◽  
Line Treatment ◽  
Second Line ◽  
Wild Type ◽  
Efficacy Evaluation ◽  
Open Label ◽  
Type K ◽  
Grade 3 ◽  
Colorectal Cancer Patients

3513 Background: More efficient second line treatment regimen for mCRC is urgently needed. CMAB009, a recombinant human/mouse chimeric monoclonal antibody, is specifically targeting human epidermal growth factor receptor. This study aimed to determine clinical efficacy and safety of CMAB009 plus irinotecan compared with irinotecan alone in wild-type K-ras mCRC patients (pts). Methods: This is a open-label, randomized, phase 3 trial. Patients had histologically confirmed wild-type K-ras mCRC, who previous failure of 5-fuorouracil plus oxaliplatin more than 1 month of the last-dose enrolled in study. Pts were randomly assigned on a 2:1 to receive CMAB009 (initial 400mg/m2 on day 1, and then 250 mg/m2 weekly) plus irinotecan (180mg/m2, every 2 weeks) (A arm) or irinotecan alone (B arm). B arm pts could switch to CMAB009 sequential treatment (C arm) on diseas progression. The primary end point was overall response rate (ORR). The secondary endpoints were PFS, OS, DCR, and DOR (NCT01550055). Results: From May 2009 to December 2012, 512 pts were assigned from 38 sites. Efficacy evaluation could be in 501 pts, ORR were 33.2% (112/337) and 12.8% (21/164) in A arm and B arm ( p <0.0001). C arm had 115 pts, DCR was 63.5% (73/115). DOR in A arm and B arm were 210 days and 109 days ( p=0.001). In C arm, DOR was 148 days . Median PFS was significantly longer in A arm than B arm (169 days vs 95 days; p < 0.0001). In C arm, median PFS was 84 days. Median OS was 425 days in A arm and 401 days in B arm ( p=0.94). 96.2% (484/503) pts experienced at least one adverse event (AE). 55.3%(187/338) and 37.6%(62/165) patients in A arm and B arm had at least one grade ≥3 AE respectively. The most common AE included diarrhea, emesis, leucopenia, neutropenia and fatigue. Adding CMAB009 to irinotecan increased the risk of rash (66.6% vs 5.5%, p <0.001) and paronychia (9.8% vs 0,p < 0.001). Conclusions: CMAB009 plus irinotecan significantly increased ORR and prolonged PFS compared with irinotecan alone. CMAB009 plus Irinotecan were efficient and well tolerated, which could be considered as a standard second-line treatment choice in wild-type K-ras mCRC pts. Clinical trial information: NCT01550055.

scholarly journals Reducing wait time for administration of systemic anticancer treatment (SACT) in a hospital outpatient facility

2020 ◽  
Vol 9 (4) ◽  
pp. e000904
Author(s):  
Angeline Macleod ◽  
Fiona Campbell ◽  
Derick Macrae ◽  
Evelyn Gray ◽  
Leanne Miller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Experience ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Wait Time ◽  
Median Number ◽  
Lean Principles ◽  
Appointment Time ◽  
Anticancer Treatment ◽  
Number Of Treatment

The demand for systemic anticancer treatment continues to rise due to the increasing numbers being diagnosed with cancer and developments in treatment options. The net result is greater pressure on services and subsequent patient delays. Delays in treatment could decrease the benefit of the therapy and be detrimental to patient experience. Patients with human epidermal growth factor receptor-2 (HER 2) positive breast cancer within Raigmore Hospital waited an average of 41 min from the scheduled appointment time despite the administration of subcutaneous (SC) trastuzumab being scheduled for a 15 min treatment window. Given the frequency of these injections, this was having an adverse impact on patients and services. The aim of this project was for patients with breast cancer to receive treatment within the 15 min window. Lean principles were applied to reduce waste and increase value. Exploration of the problem led to the solution of relocating the administration of SC trastuzumab from the Macmillan Day Bed Unit (MDBU) to the Highland Breast Centre (HBC). Multiple improvement tools and techniques were used to implement the change. Data were collected on the median number of treatment episodes of SC trastuzumab per week at baseline and patient wait from appointment time to treatment completion was calculated at baseline and as an ongoing measure. Patient experience feedback was gathered following relocation of the treatment. Following relocation, the average time from scheduled appointment to discharge was 14 min (66% reduction). Patient experience feedback was positive and identified an unanticipated outcome; the regular Friday afternoon clinic, identified as most efficient for the service, was found by patients to be particularly convenient for their own planning. Through the application of Lean principles, the service was redesigned in a cost neutral way and resulted in a reduction in the wait time for treatment.

scholarly journals Deletions on Chromosome Y and Downregulation of the SRY Gene in Tumor Tissue Are Associated with Worse Survival of Glioblastoma Patients

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1619
Author(s):  
Małgorzata Łysiak ◽  
Anja Smits ◽  
Kenney Roy Roodakker ◽  
Elisabeth Sandberg ◽  
Anna Dimberg ◽  
...  
Keyword(s):  
Gene Expression ◽  
Overall Survival ◽  
Growth Factor ◽  
Growth Factor Receptor ◽  
Enrichment Analysis ◽  
Digital Pcr ◽  
Gene Set Enrichment Analysis ◽  
Wild Type ◽  
Chromosome Y ◽  
Rank Analysis

Background: Biological causes of sex disparity seen in the prevalence of cancer, including glioblastoma (GBM), remain poorly understood. One of the considered aspects is the involvement of the sex chromosomes, especially loss of chromosome Y (LOY). Methods: Tumors from 105 isocitrate dehydrogenase (IDH) wild type male GBM patients were tested with droplet digital PCR for copy number changes of ten genes on chromosome Y. Decreased gene expression, a proxy of gene loss, was then analyzed in 225 IDH wild type GBM derived from TCGA and overall survival in both cohorts was tested with Kaplan–Meier log-rank analysis and maximally selected rank statistics for cut-off determination. Results: LOY was associated with significantly shorter overall survival (7 vs. 14.6 months, p = 0.0016), and among investigated individual genes survival correlated most prominently with loss of the sex-determining region Y gene (SRY) (10.8 vs. 14.8 months, p = 0.0031). Gene set enrichment analysis revealed that epidermal growth factor receptor, platelet-derived growth factor receptor, and MYC proto-oncogene signaling pathways are associated with low SRY expression. Conclusion: Our data show that deletions and reduced gene expression of chromosome Y genes, especially SRY, are associated with reduced survival of male GBM patients and connected to major susceptibility pathways of gliomagenesis.

scholarly journals Prognostic significance of NDRG2 combined with EGFR patients with lung adenocarcinoma

2020 ◽  
Author(s):  
Bo Yang ◽  
Xiao-Ping Li ◽  
Hong-Gang Zhou ◽  
Tao Jiang ◽  
Ting Xiao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Lung Adenocarcinoma ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Growth Factor Receptor ◽  
Serum Levels ◽  
Clinicopathological Characteristics ◽  
Cox Regression Analysis ◽  
Egfr Expression

Abstract Background: N-myc downstream-regulated gene 2 (NDRG2) plays a substantial role in lung adenocarcinoma (LUAD). Epidermal growth factor receptor (EGFR) mutation could significantly improve prognosis in patients with LUAD. In this study, we aimed to elucidate the prognostic value of NDRG2/EGFR in patients with LUAD. Methods: Immunohistochemistry, western blotting, and real-time polymerase chain reaction (RT-PCR) were conducted to detect the expression levels of NDRG2 protein. Associations between NDRG2/EGFR expression and clinicopathological characteristics of patients with LUAD were examined as well. Serum levels of carcinoembryonic antigen (CEA) were tested prior to treatments. Patients’ overall survival (OS) was assessed by the Kaplan-Meier method. Multivariate Cox regression analysis was carried out to investigate the effects of patients’ demographic characteristics on overall survival . Results: The expression of NDRG2 was significantly decreased in patients with LUAD. The expression of NDRG2 was positively correlated with the levels of CEA and EGFR. Advanced stages were significantly associated with low expression of NDRG2. We found that the patients in the NDRG2-high/EGFR(+) group had the best outcomes, while the patients in the NDRG2-low/EGFR(-) group had the worst outcomes. Cox regression analysis showed that NDRG2-low/EGFR(+), NDRG2-high/EGFR(+), and vascular invasion were independent prognostic factors of LUAD. Conclusion: NDRG2 and EGFR should be considered in patients with LUAD.

scholarly journals Exploratory pooled analysis evaluating the effect of sequence of biological therapies on overall survival in patients with RAS wild-type metastatic colorectal carcinoma

ESMO Open ◽  
2018 ◽  
Vol 3 (2) ◽  
pp. e000297 ◽  
Author(s):  
Marc Peeters ◽  
Frédéric Forget ◽  
Meinolf Karthaus ◽  
Manuel Valladares-Ayerbes ◽  
Alberto Zaniboni ◽  
...  
Keyword(s):  
Overall Survival ◽  
Growth Factor ◽  
Colorectal Carcinoma ◽  
Growth Factor Receptor ◽  
Second Line ◽  
Wild Type ◽  
Metastatic Colorectal Carcinoma ◽  
First Line ◽  
Optimal Sequence ◽  
Link Type

BackgroundThe aim of this study was to evaluate the optimal sequence of targeted therapies (epidermal growth factor receptor inhibitors (EGFRi) and vascular endothelial growth factor inhibitors (VEGFi)), combined with chemotherapy, in patients with RAS wild-type (WT) metastatic colorectal carcinoma (mCRC). Exploratory analyses of overall survival (OS) for patients treated with either first-line panitumumab (EGFRi) and second-line VEGFi therapy, or first-line bevacizumab (VEGFi) and second-line EGFRi, were conducted.MethodsPatients from PEAK (NCT00819780), PRIME (NCT00364013) and Study 181 (NCT00339183), with RAS WT or RAS WT/BRAF WT tumours, were included in the analyses. OS data were pooled for patients receiving first-line panitumumab (PEAK and PRIME) or first-line bevacizumab (PEAK and 181), followed by second-line VEGFi or EGFRi, respectively.ResultsOverall, 104 RAS WT patients were included (n=66 panitumumab→VEGFi, n=38 bevacizumab→EGFRi). At the time of final data analysis, 63.6% versus 92.1% of patients in the panitumumab→VEGFi versus bevacizumab→EGFRi arms had died; median OS was 36.8 versus 27.8 months, respectively (HR 0.65; 95% CI 0.42 to 1.03). The OS HR for patients with RAS WT/BRAF WT mCRC overall was 0.58 (95% CI 0.36 to 0.95) and was 0.56 (95% CI 0.30 to 1.04) in those with left-sided tumours.ConclusionAlthough numbers are small, these exploratory analyses suggest a trend towards improved OS for first-line panitumumab plus chemotherapy followed by second-line VEGFi, compared with first-line bevacizumab followed by second-line EGFRi in patients with RAS WT and RAS WT/BRAF WT mCRC. Large prospective randomised trials are needed to further evaluate the optimum sequence of EGFRi/VEGFi in mCRC.

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