Real-world practices in RAS wild-type metastatic colorectal cancer patients treated with targeted agents in the first-line a nationwide onco-colon Turkey registry
Öz
Aim: Efficacy of antiepidermal growth factor receptor (anti-EGFR) agents has been demonstrated in metastatic colorectal cancer (mCRC). Real-world evidence is especially important to detect patient findings outside of clinical trials. Therefore; we aimed to investigate the real-world data in patients with RAS wild-type mCRC.
Methods: Medical records from 28 centers were collected for patients diagnosed with mCRC between January 2016 and April 2019. Patients were compared according to the first-line biological treatments as anti-EGFR group (Group A (panitumumab) and B (cetuximab)) and anti-VEGF group (Group C).
Results: A total of 1064 patients with documented RAS wild-type mCRC were evaluated. Of these; 33%; 37% and 30% were treated with regimens including panitumumab; cetuximab; and anti-VEGF in the first-line; respectively. Overall response rate was 46.4%; 41.9% and 41.5% in A; B; and C groups; respectively (p = 0;170). The median OS was 26; 27; and 23 months in A; B and C group respectively (p = 0.044). The median PFS of the patients that treated with panitumumab; cetuximab and bevacizumab was 11;6; 11;0 and 9;6 months respectively (p = 0.012). ECOG performance status (PS) 0-1 and Braf wild-type status were found as independent prognostic factors in multivariate analysis for OS and only BRAF wild-type status for PFS (p<0.05).
Conclusion: This analysis of real-world data confirms the comparable efficacy of anti-EGFR agents in RAS wild-type mCRC. However; anti-EGFR treatment provides PFS and OS advantage when compared with anti-VEGF treatment in these patients. Also; Braf wild-type tumors had improved PFS and OS in RAS wild-type mCRC.
Anahtar Kelimeler
Cetuximab, colorectal neoplasms, epidermal growth factor receptor, panitumumab, vascular endothelial growth factor B
Kaynakça
- Siegel RL; Miller KD; Fuchs HE; Jemal A. Cancer Statistics; 2021. CA Cancer J Clin. 2021;71(1):7-33.
- van der Geest LG; Lam-Boer J; Koopman M; Verhoef C; Elferink MA; de Wilt JH. Nationwide trends in incidence; treatment and survival of colorectal cancer patients with synchronous metastases. Clin Exp Metastasis. 2015;32(5):457-65.
- Stintzing S; Modest DP; Rossius L; et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab for metastatic colorectal cancer (FIRE-3): a post-hoc analysis of tumour dynamics in the final RAS wild-type subgroup of this randomised open-label phase 3 trial. Lancet Oncol. 2016;17(10):1426-34.
- Venook AP; Niedzwiecki D; Lenz HJ; et al. Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: a randomized clinical trial. JAMA. 2017;317(23):2392-401.
- Loree JM; Pereira AAL; Lam M; et al. Classifying colorectal cancer by tumor location rather than sidedness highlights a continuum in mutation profiles and consensus molecular subtypes. Clin Cancer Res. 2018;24(5):1062-72.
- Tejpar S; Stintzing S; Ciardiello F; et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol. 2017;3(2):194-201.
- Snyder LC; Astsaturov I; Weiner LM. Overview of monoclonal antibodies and small molecules targeting the epidermal growth factor receptor pathway in colorectal cancer. Clin Colorectal Cancer. 2005;5(2):71-80.
- Oken MM; Creech RH; Tormey DC; et al. Toxicity and response criteria of the Eastern cooperative oncology group. Am J Clin Oncol. 1982;5(6):649-55.
- Miller AB; Hoogstraten B; Staquet M; Winkler A. Reporting results of cancer treatment. Cancer. 1981;47(1):207-14.
- Abdel-Rahman O. Impact of sex on chemotherapy toxicity and efficacy among patients with metastatic colorectal cancer: pooled analysis of 5 randomized trials. Clin Colorectal Cancer. 2019;18(2):110-15.