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Posted by on Jan 9, 2022 in Colorectal cancer | 0 comments

In a nutshell

This study evaluated the effectiveness and safety of maintenance strategies after first-line treatment with anti-EGFR (epidermal growth factor receptor) plus doublet chemotherapy regimen in real-world patients with left-sided RAS/BRAF wild-type metastatic colorectal cancer (mCRC). The data showed that maintenance therapy with 5-fluorouracil (5FU; Adrucil)/leucovorin (LV; Folinic acid) plus anti-EGFR was the most adopted, effective, and safe regimen for these patients.

Some background

Patients who are diagnosed with mCRC have cancer that has spread to other areas. A distinct group of these patients has cancer that began in the left side of the large intestine. This is termed as left-sided mCRC. Genetic changes (mutations) in RAS and BRAF proteins can often occur to promote mCRC growth and spread. mCRC tumors that do not have these genetic changes are termed as RAS/BRAF wild-type mCRC. The standard treatment for these patients is chemotherapy combined with targeted therapy.

A combination of fluorouracil and leucovorin (FU/LV) plus either oxaliplatin (Eloxatin) (FOLFOX) or irinotecan (Camptosar) (FOLFIRI) chemotherapies are the recommended first-line therapies (induction) for mCRC. Panitumumab (Vectibix) is a type of targeted therapy. It works by targeting certain proteins (EGFR) on the cancer cells and stops them from growing. Doublet chemotherapy with anti-EGFR inhibitors such as panitumumab has been shown to improve survival in patients with left-sided RAS/BRAF wild-type mCRC.

Maintenance treatment is commonly used after first-line treatment to delay relapse or slow down cancer progression. However, there are few studies evaluating the effectiveness and safety of maintenance strategies after induction with anti-EGFR plus doublet chemotherapy regimen in real-world patients with left-sided RAS/BRAF wild-type mCRC.

Methods & findings

This study involved 355 patients with left-sided RAS/BRAF wild-type mCRC. All patients were treated with doublet chemotherapy plus anti-EGFR therapy as a first-line regimen. After this, patients were divided into four groups according to the maintenance therapy they received. Group 1 included 118 patients who received maintenance therapy with 5FU/LV plus anti-EGFR. Group 2 included 66 patients who received maintenance therapy with anti-EGFR alone. Group 3 included 11 patients who received maintenance therapy with 5FU/LV alone. Group 4 included 160 patients who received no maintenance therapy and continued induction therapy. The average follow-up time was 33.7 months.

The average survival without cancer worsening was 16 months for group 1, 13 months for group 2, 14 months for group 3, and 10.1 months for group 4. Patients in group 1 were 41% more likely to survive without cancer worsening than patients in group 4. Patients in group 2 were 29% more likely to survive without cancer worsening than patients in group 4.

The average overall survival was 39.6 months for group 1, 36.1 months for group 2, 39.5 months for group 3, and 25.1 months for group 4. Patients in group 1 were 45% more likely to have a better survival than patients in group 4. Patients in group 2 were 33% more likely to have a better survival than patients in group 4.

The objective response rate (ORR; partial or complete disappearance of cancer) was 78% for group 1, 79.4% for group 2, 81.8% for group 3, and 71.3% for group 4. Non-blood and blood-related side effects were higher in group 4 compared to the maintenance groups.

The bottom line

This study concluded that maintenance therapy with 5FU/LV plus anti-EGFR was the most adopted, effective, and safe regimen for the treatment of patients with left-sided RAS/BRAF wild-type mCRC.

The fine print

This study looked back in time at medical records. The sample size was small.

Published By :

Frontiers in oncology

Date :

Nov 16, 2021

Original Title :

Post-Induction Management in Patients With Left-Sided RAS and BRAF Wild-Type Metastatic Colorectal Cancer Treated With First-Line Anti-EGFR-Based Doublet Regimens: A Multicentre Study.

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