Cetuximab as a second line treatment in metastatic colorectal cancer

This study investigated the effectiveness of the chemotherapy FOLFOX plus cetuximab (Erbitux), after cancer progression with FOLFIRI plus cetuximab. Researchers suggested that FOLFOX plus cetuximab is an important treatment option in non-KRAS mutated metastatic (spread to other parts of the body) colorectal cancer.

Chemotherapy drugs attack cancer cells, slowing down cancer progression. Different chemotherapy drugs can be used and often are combined to increase effectiveness. FOLFOX chemotherapy combines the agents folinic acid, flourouacil (5-FU) and oxaliplatin.

More recently, the addition of targeted therapies like cetuximab that block the tumor from growing has been shown to provide an additional benefit. In prior studies, other targeted therapies were shown to be active after cancer progression with first-line treatment. It is not clear whether treatment with cetuximab as a second-line treatment has the same effect.  

The objective of this study was to evaluate the effect of FOLFOX plus cetuximab as a second-line treatment for progressing colorectal cancer.

This study included 153 patients with metastatic colorectal cancer that progressed after treatment with FOLFIRI and cetuximab. Patients were randomized to receive FOLFOX plus cetuximab (group 1; 74 patients) or FOLFOX alone (group 2; 79 patients). Progression-free survival (PFS; time from treatment to progression) was determined.

The average PFS was 6.4 months for group 1 and 4.5 months for group 2. Patients without the tumor mutations (permanent change) BRAF, KRAS, NRAS and PIK3CA had a 44% improvement in the odds of a better PFS with cetuximab treatment. Patients without the mutations had a 43% improvement in the odds of a better overall survival (time from treatment until death from any cause). 

This study concluded that FOLFOX plus cetuximab as a second line treatment was associated with an improved PFS and overall survival when compared to FOLFOX alone.