Bevacizumab (Bev) with or without erlotinib as maintenance therapy, in patients (pts) with metastatic colorectal cancer (mCRC): Exploratory analysis according to KRAS status in the gercor DREAM phase III trial.

Authors

null

Benoit Samson

Hopital Charles-LeMoyne

Benoit Samson , Christophe Tournigand , Werner Scheithauer , Gérard Lledo , Frédéric Viret , Thierry André , Jean François Ramée , Nicole Tubiana-Mathieu , Jérôme Dauba , Olivier Dupuis , Yves Rinaldi , May Mabro , Nathalie Aucoin , Ahmed Khalil , Jean Latreille , Christophe Louvet , David Brusquant , Franck Bonnetain , Benoist Chibaudel , Aimery De Gramont

Organizations

Hopital Charles-LeMoyne, Hopital Henri Mondor, Medical University of Vienna, Hôpital Privé Jean Mermoz, Institut Paoli-Calmettes, Hopital Saint-Antoine, Centre Catherine de Sienne, CHU de Limoges, Centre Hospitalier Layné, Clinique Victor Hugo, Hôpital Ambroise Paré, Hôpital Foch, Cite De La Sante De Laval, Hôpital Tenon, Hopital Charles LeMoyne, Department of Oncology, Institut Mutualiste Montso, GERCOR, CHU, Hospital Saint Antoine

Research Funding

Pharmaceutical/Biotech Company

Background: In the GERCOR-DREAM trial, maintenance therapy (MT) with bev + EGFR tyrosine kinase inhibitor erlotinib (E) after a first-line Bev-based induction therapy (IT) in pts with mCRC significantly improved PFS compared with bev alone. Here we explore the influence of KRAS status on erlotinib efficacy. Methods: Pts with previously untreated and unresectable mCRC were eligible. After a Bev-based IT with FOLFOX or XELOX or FOLFIRI, pts without disease progression were randomized to MT between Bev alone (Bev 7.5 mg/kg q3w; arm A) or Bev+E (Bev 7.5 mg/kg q3w, E 150 mg/day continuously; arm B). KRAS determination was established by local assessment in each center. Results: Among the 452 randomized patients, KRAS status was available in 403 pts (89%): 234 pts (58%) KRAS wt and 169 pts (42%) KRAS mut. Clinical characteristics were similar between both populations. For the whole population of randomized patients (n=452), median PFS from inclusion were 9.33m and 10.55m in arm A and B, respectively (HR=0.76 [0.61-0.94], p=0.011). For KRAS wt population, median PFS from inclusion was 9.66 m and 10.94 m in arm A and B, respectively (HR=0.80 [0.59-1.08], p=0.141). For KRAS mut population, median PFS from inclusion was 9.79 m and 9.79 m in arm A and B, respectively (HR=0.86 [0.61-1.22], p=0.393). In KRAS wt pts treated with erlotinib, cutaneous toxicity was predictive of PFS: mPFS was 9.66m in pts with grade 0 (n=101) and 10.91m in pts with grade ≥1 (n=114) (HR=0.69 [0.51-0.95], p=0.0186). Conclusions: The addition of erlotinib to bevacizumab as maintenance treatment in first-line metastatic colorectal cancer significantly improves progression-free survival from inclusion. However, in both wt and mut KRAS pts, difference was not statistically significant. Unlike anti-EGFR monoclonal antibodies, the addition of erlotinib to bevacizumab does not appear to be antagonist in KRAS mutant patients. Clinical trial information: NCT00265824.

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Abstract Details

Meeting

2013 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

General Poster Session C: Cancers of the Colon and Rectum

Track

Cancers of the Colon, Rectum, and Anus

Sub Track

Multidisciplinary Treatment

Clinical Trial Registration Number

NCT00265824

Citation

J Clin Oncol 31, 2013 (suppl 4; abstr448)

DOI

10.1200/jco.2013.31.4_suppl.448

Abstract #

448

Poster Bd #

C4

Abstract Disclosures