Colorectal Cancer Liver Metastases by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030254865
Publisher: Springer International Publishing

Intensive Treatment with EGFR Inhibitors

Use of the EGFR inhibitors corresponded to an era of increased utilization of molecular testing of tumor tissue, and many studies evaluating their use underwent subgroup analyses based on KRAS (an oncogene) mutation status given the significant correlations found. For this reason, information provided in this section will focus on utilization based on KRAS subtype.

The use of cetuximab with all first-line doublet regimens has demonstrated safety and efficacy [33, 34] and shown a promise with increased resection rates in synchronous disease [35]. Early studies found an increase in progression-free survival and response rate in combination with oxaliplatin- and irinotecan-containing regimens, but failed to show overall survival benefit [36, 37]. After separation of KRAS wild-type (wt) and mutant genotypes, wild-type disease did exhibit an improvement in survival over cytotoxic therapy alone [38]. Panitumumab was shown to be safe [39] and demonstrated similar results in phase III trials with first-line doublet regimens [40].

Importantly, a subgroup analysis of the OPUS trial comparing FOLFOX with and without cetuximab regardless of KRAS status saw no benefit and potentially detrimental effects in RAS mutants (both KRAS and NRAS) [41]. Similarly, panitumumab was associated with decreased progression-free and overall survival in this population [42]. For this reason, anti-EGFR antibody therapy is only recommended for RAS wt patients by major published guidelines [43, 44].

FOLFOXIRI and cetuximab have been investigated in a recent phase II trial and resulted in a high surgical resection rate similar to triplet therapy plus bevacizumab [45], but data from large, phase III trials is yet to be published on its use in this setting.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.