Use of Monoclonal Antibodies (Bevacizumab, Cetuximab, and Panitumumab) in Patients with Metastatic Colorectal Cancer: A Single Center Experience

Year 2022, Volume: 39 Issue: 4, 1112 - 1119, 29.10.2022

Gülçin Şahingöz Erdal İlkay Gültürk Aykut Özmen Seher Yıldız Tacar Mesut Yılmaz Deniz Tural

Abstract

Introduction: Despite all the advances in therapeutic modalities, Colorectal Cancer(CRC) continues to be the fourth most common cause of cancer-related deaths. The aim of this study was to share our experiences regarding the usage rates of monoclonal antibodies(mAbs) (such as Bevacizumab, Cetuximab, and Panitumumab), overall survival(OS) and progression-free survival(PFS) in patients with metastaticCRC(mCRC).
Material metod: This retrospective study included 210 patients with mCRC who were followed up in our hospital's oncology clinic between January 2010 and October 2020 and who received mAb treatment, regardless of their stage at the time of diagnosis.
Results: Fifty-two(24.8%) of the patients received a treatment regimen with Cetuximab and 46 with Panitumumab mAb, 29 patients(17.8%) received Cetuximab and Bevacizumab mAb treatment at different times, and 22 patients received Panitumumab and Bevacizumab mAb treatment, 112 of the patients received only Bevacizumab treatment. Panitumumab and Cetuximab mAb treatment was mostly taken in the 1st lines(69.6%, 76.9%, respectively). A statistically significant difference was found between the OSs of the cases according to the mAb treatment received(p=0.001). Administration of Panitumumab and Cetuximab mAb in the 1st or 2nd series didn’t make a significant difference to PFS.
Discussion: The distribution of Panitumumab and Cetuximab mAb treatments was found to be balanced. They were preferred to give it in the first line. Patients who received anti EGFR mAb treatment had longer OS and PFS duration than those who received anti VEGF mAb only. It can be said that taking anti EGFR mAb treatment(being KRAS WT) has a positive effect on prognosis.

Keywords

colon cancer, bevacizumab, cetuximab, panitimumab

References

• 1. American Cancer Society. Global Cancer Facts & Figures 4th Edition American Cancer Society, 2018. Accessible at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-4th-edition.pdf. [Google Scholar]
• 2. American Cancer Society. Cancer Facts & Figures 2019. American Cancer Society, 2019. Accessible at https://www.cancer.org/latest-news/facts-and-figures-2019.html. [Google Scholar]
• 3. Mitry E, Fields ALA, Bleiberg H, Labianca R, Portier G, Tu D, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol [Internet]. 2008;26(30):4906–11. Available from: http://dx.doi.org/10.1200/JCO.2008.17.3781.
• 4. Rougier P, Mitry E. Cancers colorectaux avant et après les biothérapies : une révolution dans la prise en charge des patients ? Gastroentérologie Clinique et Biologique [Internet]. 2009;33(8– 9):672–80. Available from: http://dx.doi.org/10.1016/j. gcb.2009.07.019.].
• 5. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol [Internet]. 2000;18(16):2938–47.
• 6. Yamaguchi T, Iwasa S, Nagashima K, Ikezawa N, Hamaguchi T, Shoji H, et al. Comparison of panitumumab plus irinotecan and cetuximab plus irinotecan for KRAS wild-type metastatic colorectal cancer. Anticancer Res.].
• 7. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol [Internet]. 2000;18(16):2938–47.
• 8. Gullick WJ. Prevalence of aberrant expression of the epidermal growth factor receptor in human cancers. Br Med Bull 1991;47:87-98.
• 9. Herbst RS, Shin DM. Monoclonal antibodies to target epidermal growth factor receptor-positive tumors: a new paradigm for cancer therapy. Cancer 2002;94:1593-1611.
• 10. US Food and Drug Administration. FDA approves Erbitux for colorectal cancer. Available at: www.Fda.Gov [Last accessed 2004].
• 11. US Food and Drug Administration. FDA approves Vectibix (panitumumab) to treat metastatic colorectal carcinoma. Available at: www.Fda.Gov [Last accessed 2007].
• 12. Chou T, Finn RS. Brivanib: A review of development. Future Oncol 2012;8:1083.)
• 13. Ferrara, N. et al. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nature Rev. Drug Discov. 3, 391–400 (2004).
• 14. Ellis LM, Bernstein DS, Voest EE, Berlin JD, Sargent D, Cortazar P, et al. American Society of Clinical Oncology perspective: raising the bar for clinical trials by defining clinically meaningful outcomes. J Clin Oncol [Internet]. 2014;32(12):1277–80. Available from: http://dx.doi.org/10.1200/jco.2013.53.8009
• 15. Allemani C, Matsuda T, Di Carlo V et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD‐3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population‐based registries in 71 countries. Lancet 2018; 391: 1023– 75.
• 16.Fancher TT, Palesty JA, Rashidi L, Dudrick SJ. Is gender related to the stage of colorectal cancer at initial presentation in young patients? J Surg Res. 2011;165:15-18.
• 17. Al-Barrak J, Gill S. Presentation and outcomes of patients aged 30 years and younger with colorectal cancer: a 20-year retrospective review. Med Oncol. 2011;28:1058–1061.
• 18. da Fonseca LM, da Luz MM, Lacerda-Filho A, Cabral MM, da Silva RG. Colorectal carcinoma in different age groups: a histopathological analysis. Int J Colorectal Dis. 2012;27:249–255. [PubMed] [Google Scholar]
• 19. Engstrand, J., Nilsson, H., Strömberg, C. et al. Colorectal cancer liver metastases – a population-based study on incidence, management and survival. BMC Cancer 18, 78 (2018). https://doi.org/10.1186/s12885-017-3925-x
• 20. Vishal Das, Jatin Kalita, Mintu Pal, Predictive and prognostic biomarkers in colorectal cancer: A systematic review of recent advances and challenges, Biomedicine & Pharmacotherapy, Volume 87, 2017, Pages 8-19, ISSN 0753-3322, https://doi.org/10.1016/j.biopha.2016.12.064.
• 21. Yazdi, M. H., Faramarzi, M. A., Nikfar, S., & Abdollahi, M. (2015). A Comprehensive Review of Clinical Trials on EGFR Inhibitors Such as Cetuximab and Panitumumab as Monotherapy and in Combination for Treatment of Metastatic Colorectal Cancer. Avicenna journal of medical biotechnology, 7(4), 134–144.
• 22. He, W. Z., Liao, F. X., Jiang, C., Kong, P. F., Yin, C. X., Yang, Q., Qiu, H. J., Zhang, B., & Xia, L. P. (2017). Primary Tumor Location as a Predictive Factor for First-line Bevacizumab Effectiveness in Metastatic Colorectal Cancer Patients. Journal of Cancer, 8(3), 388–394. https://doi.org/10.7150/jca.16804
• 23. Bufill JA. Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med. 1990;113(10):779–788.
• 24. Distler P, Holt PR. Are right- and left-sided colon neoplasms distinct tumors? Dig Dis. 1997;15(4–5):302–311.
• 25. Iacopetta B. Are there two sides to colorectal cancer? Int J Cancer. 2002;101(5):403–408 Glebov OK, Rodriguez LM, Nakahara K, et al. Distinguishing right from left colon by the pattern of gene expression. Cancer Epidemiol Biomarkers Prev. 2003;12(8):755–762.
• 26. Birkenkamp-Demtroder K, Olesen SH, Sørensen FB, et al. Differential gene expression in colon cancer of the caecum versus the sigmoid and rectosigmoid. Gut. 2005;54(3):374–384.
• 27. Meguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N. Is there a difference in survival between right- versus left-sided colon cancers? Ann Surg Oncol. 2008;15(9):2388–2394.
• 28. Benedix F, Kube R, Meyer F, et al. Colon/Rectum Carcinomas (Primary Tumor) Study Group. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010;53(1):57–64.
• 29. Weiss JM, Pfau PR, O’Connor ES, et al. Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results—Medicare data. J Clin Oncol. 2011;29(33):4401–4409.
• 30. Petrelli, F., Borgonovo, K., Cabiddu, M. et al. Cetuximab and panitumumab in KRAS wild-type colorectal cancer: a meta-analysis. Int J Colorectal Dis 26, 823–833 (2011). https://doi.org/10.1007/s00384-011-1149-0
• 31. Fornasier G, Taborelli M, Francescon S, et al. Targeted therapies and adverse drug reactions in oncology: the role of clinical pharmacist in pharmacovigilance. Int J Clin Pharm. 2018;40(4):795–802 32. Fabbrocini G, Romano MC, Cameli N, et al. “Il corpo ritrovato”: dermocosmetological skin care project for the oncologic patient. ISRN Oncol. 2011;2011:650482.
• 33. Pinto C, Barone CA, Girolomoni G, et al. Management of skin toxicity associated with cetuximab treatment in combination with chemotherapy or radiotherapy. Oncologist. 2011;16(2):228–38.
• 34.Tougeron, D., Emambux, S., Favot, L., Lecomte, T., Wierzbicka-Hainaut, E., Samimi, M., et al. (2020). Skin inflammatory response and efficacy of anti-epidermal growth factor receptor therapy in metastatic colorectal cancer (CUTACETUX). OncoImmunology, 9(1), 1848058. doi:10.1080/2162402x.2020.1848058
• 35. Timothy J Price, Marc Peeters, Tae Won Kim, Jin Li, Stefano Cascinu, Paul Ruff, et al., Panitumumab versus cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer (ASPECCT): a randomised, multicentre, open-label, non-inferiority phase 3 study, The Lancet Oncology, Volume 15, Issue 6, 2014, Pages 569-579, ISSN 1470-2045, https://doi.org/10.1016/S1470-2045(14)70118-4. (http://www.sciencedirect.com/science/article/pii/S1470204514701184