Queen Elizabeth Hospital, University of Adelaide, Woodville, Australia
Timothy Jay Price , Lin Shen , Brigette Ma , Regina Esser , Wen-Feng Chen , Peter Gibbs , Robert S.C. Lim , Ann-Lii Cheng
Background: In the RAS wt population of APEC, q2w cetuximab combined with first-line FOLFOX or FOLFIRI achieved an overall response rate (ORR), median progression-free survival (PFS), and median overall survival (OS) similar to those reported in prior first-line pivotal studies involving weekly cetuximab. In this subgroup analysis, we evaluated the impact of tumor side in the APEC study population with RAS wt mCRC. Methods: APEC was a nonrandomized phase 2 trial conducted in the Asia-Pacific region, with ORR as the primary endpoint. Patients with KRAS exon 2 wt tumors received q2w cetuximab + investigator’s choice of FOLFOX or FOLFIRI. Tumor side was categorized in evaluable patients with RAS wt tumors (left [L]-sided = splenic flexure, descending colon, sigmoid colon, and rectum; right [R]-sided = appendix, cecum, ascending colon, hepatic flexure, and transverse colon). Results: Among 167 patients with RAS wt mCRC, 159 were evaluable for tumor side; 130 (81.8%) had L-sided and 29 (18.2%) had R-sided mCRC. Baseline characteristics in the tumor side subgroups reflected the known differences between L- and R-sided mCRC; indeed, 95.4% and 75.9% of patients had BRAF wt disease, respectively. Efficacy data are summarized in the Table. Conclusions: Consistent with prior first-line pivotal studies with weekly cetuximab, a prognostic effect of tumor side in patients receiving first-line q2w cetuximab was confirmed in APEC. In patients with R-sided mCRC, ORR remained ≥ 50%, and resection rate was comparable to that of L-sided patients, in line with prior evidence showing that use of cetuximab may be appropriate when rapid tumor shrinkage is the goal. These hypothesis-generating data raise the possibility of a synergy between cetuximab and irinotecan in patients with R-sided tumors, although numbers are small. Clinical trial information: NCT00778830
L-side | R-side | |||||
---|---|---|---|---|---|---|
Cetuximab + FOLFIRI | Cetuximab + FOLFOX | Total | Cetuximab + FOLFIRI | Cetuximab + FOLFOX | Total | |
n | 43 | 87 | 130 | 10 | 19 | 29 |
ORR, % | 74.4 | 65.5 | 68.5 | 50.0 | 52.6 | 51.7 |
Median PFS, months | 12.8 | 14.2 | 14.0 | 15.4 | 8.3 | 8.9 |
Median OS, months | 31.7 | 30.6 | 30.6 | 32.1 | 21.8 | 24.6 |
Resection rate, % | 2.3 | 14.9 | 10.8 | 10.0 | 10.5 | 10.3 |
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Abstract Disclosures
2023 ASCO Annual Meeting
First Author: Nicola Normanno
2018 Gastrointestinal Cancers Symposium
First Author: Timothy Jay Price
2023 ASCO Gastrointestinal Cancers Symposium
First Author: Hsiang-Lin Tsai
2015 Gastrointestinal Cancers Symposium
First Author: Ann-Lii Cheng