Are BRAF mutated metastatic colorectal cancer (mCRC) tumors more responsive to VEGFR-2 blockage? Analysis of patient outcomes by RAS/RAF mutation status in the RAISE study—A global, randomized, double-blind, phase III study.

Authors

null

Takayuki Yoshino

National Cancer Center Hospital East, Kashiwa, Japan

Takayuki Yoshino , Radka Obermannova , Gyorgy Bodoky , Jana Prausová , Rocio Garcia-Carbonero , Tudor-Eliade Ciuleanu , Pilar Garcia Alfonso , David Craig Portnoy , Allen Lee Cohn , Eric Van Cutsem , Kentaro Yamazaki , Philip Clingan , Kei Muro , Tae Won Kim , Sameera R. Wijayawardana , Rebecca Hozak , Federico Nasroulah , Josep Tabernero

Organizations

National Cancer Center Hospital East, Kashiwa, Japan, Masaryk Memorial Cancer Institute, Brno, Czech Republic, Szent László Teaching Hospital, Budapest, Hungary, University Hospital Motol, Prague, Czech Republic, Hospital Universitario, Madrid, Spain, Chiricuta Institute of Oncology, Cluj County, Romania, Hospital General Universitario Gregorio Marañón, Madrid, Spain, The West Clinic, Memphis, TN, Rocky Mountain Cancer Center, US Oncology, Denver, CO, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium, Shizuoka General Hospital Cancer Center, Shizuoka, Japan, Southern Medical Day Care Centre, Wollongong, Australia, Aichi Cancer Center Hospital, Nagoya, Japan, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), Eli Lilly and Company, Indianapolis, IN, Eli Lilly and Company, Buenos Aires, Argentina, Vall d’Hebron University Hospital Institute of Oncology, Barcelona, Spain

Research Funding

Pharmaceutical/Biotech Company

Background: The RAISE trial (NCT01183780) demonstrated that ramucirumab (RAM) plus leucovorin, fluorouracil, and irinotecan (FOLFIRI) significantly improved overall survival (OS) and progression-free survival (PFS) compared with placebo (PBO) plus FOLFIRI as second-line mCRC treatment. RAS/RAF mutations are associated with resistance to anti-EGFR therapies and poor prognosis, particularly BRAF mutations. The extensive RAISE biomarker program assessed the association of multiple candidate markers with efficacy outcomes. Here we present the results for RAS/RAF mutations. Methods: Plasma and tumor tissue collection were mandatory. KRAS mutation status was determined locally before randomization. Further RAS and RAF mutations were assessed centrally by multiplex qPCR using the Modaplex system (Qiagen) only in samples that were initially reported as KRAS wild type. Thus, patients were classified into one of the 3 categories in the table. OS and PFS by RAS and RAF subgroups were evaluated by Kaplan-Meier and Cox proportional hazards analyses. Results: As with previously reported KRAS analyses, the favorable RAM treatment effect was similar between patients with expanded RAS mutations compared with patients with RAS/RAF wild-type tumors. However, in the 41 patients with BRAF mutated tumors, the RAM benefit was even more notable for both OS (hazard ratio [HR] 0.54; 95% CI 0.25–1.13) and PFS (HR 0.55; 95% CI 0.28–1.08). Conclusions: RAISE demonstrated that the addition of RAM to FOLFIRI improved patient outcomes regardless of RAS mutation status. The noteworthy signal for patients with BRAF mutant tumors is encouraging due to their poor prognosis but requires further validation in other clinical trials. Clinical trial information: NCT01183780

SubgroupArmnMedian OS, moHR (95% CI)Median PFS, moHR (95% CI)
BRAF mutantRAM + FOLFIRI209.00.54 (0.25–1.13)5.70.55 (0.28–1.08)
PBO + FOLFIRI214.22.7
KRAS / NRAS mutantRAM + FOLFIRI28512.90.86 (0.71–1.04)5.70.81 (0.68–0.97)
PBO + FOLFIRI29411.54.3
Wild type for BRAF / KRAS / NRASRAM + FOLFIRI14916.20.86 (0.64–1.14)5.70.78 (0.61–1.00)
PBO + FOLFIRI14315.55.7

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2018 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Cancers of the Colon, Rectum, and Anus

Sub Track

Translational Research

Clinical Trial Registration Number

NCT01183780

Citation

J Clin Oncol 36, 2018 (suppl 4S; abstr 622)

DOI

10.1200/JCO.2018.36.4_suppl.622

Abstract #

622

Poster Bd #

D7

Abstract Disclosures