Impact of primary tumor side on outcomes of every-2-weeks (q2w) cetuximab + first-line FOLFOX or FOLFIRI in patients with RAS wild-type (wt) metastatic colorectal cancer (mCRC) in the phase 2 APEC trial.

Authors

Timothy Price

Timothy Jay Price

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

Organizations

Queen Elizabeth Hospital, University of Adelaide, Woodville, Australia, Peking University Cancer Hospital & Institute, Beijing, China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, Merck KGaA, Darmstadt, Germany, Merck Serono Pharmaceutical R&D Co., Ltd., Beijing, China, Western Hospital, Melbourne, Australia, National University Cancer Institute, Singapore, Singapore, National Taiwan University Hospital, Taipei, Taiwan

Research Funding

Pharmaceutical/Biotech Company

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 + FOLFIRICetuximab + FOLFOXTotalCetuximab + FOLFIRICetuximab + FOLFOXTotal
n4387130101929
ORR, %74.465.568.550.052.651.7
Median PFS, months12.814.214.015.48.38.9
Median OS, months31.730.630.632.121.824.6
Resection rate, %2.314.910.810.010.510.3

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Clinical Trial Registration Number

NCT00778830

Citation

J Clin Oncol 36, 2018 (suppl; abstr 3534)

DOI

10.1200/JCO.2018.36.15_suppl.3534

Abstract #

3534

Poster Bd #

27

Abstract Disclosures