FOLFIRINOX plus cetuximab (CET) or bevacizumab (BEV) in patients (pts) with initially unresectable colorectal liver metastases (CRLM) with BRAF mutated (mut) tumors: A subgroup analysis of the UNICANCER PRODIGE 14-ACCORD 21 (METHEP2) trial.

Authors

null

Evelyne Lopez-Crapez

Institut régional du Cancer de Montpellier ICM, Montpellier, France

Evelyne Lopez-Crapez , Antoine Adenis , Simon Thezenas , Eric Assenat , Eric Francois , Rosine Guimbaud , Marion Chauvenet , Faiza Khemissa , Franck Audemar , Etienne Suc , Michel Rivoire , François Ghiringhelli , Anne Mercier-Blas , Laurent Mineur , Yves Becouarn , Philippe Houyau , Trevor Stanbury , Claire Jouffroy-Zeller , Olivier Bouche , Marc Ychou

Organizations

Institut régional du Cancer de Montpellier ICM, Montpellier, France, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France, CHRU Saint Eloi, Montpellier, France, Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France, Hôpital Rangueil - CHU Toulouse, Toulouse, France, Hospices Civils De Lyon, Cancer Research Center of Lyon, Claude Bernard University Lyon, Pierre Béninte, France, CH Saint Jean, Perpignan, France, Centre hospitalier Côte Basque, Bayonne, France, Department of Oncology, Clinique Saint Jean du Languedoc, Toulouse, France, Centre Léon Bérard, Lyon, France, Department of Medical Oncology, Center GF Leclerc, Dijon, France, Dijon Cedex, FR, Centre Hospitalier Privé de Saint-Grégoire, Saint-Grégoire, France, Institut Sainte-Catherine, Avignon, France, Institut Bergonié, Bordeaux, France, Clinique Claude Bernard, Albi, France, UNICANCER, Paris, France, Unicancer, Paris, France, CHU Robert Debre, Reims, France

Research Funding

Pharmaceutical/Biotech Company

Background: The treatment of metastatic colorectal cancer (mCRC) pts with BRAF-mut tumors is a major challenge for physicians. They account for < 10% of mCRC, correlate with poor prognosis, and respond poorly to standard first-line regimens including chemotherapy doublets (2-CT) plus a targeted agent. Guidelines suggest treating BRAF-mut mCRC with a triplet CT regimen (3-CT; fluorouracil, irinotecan, and oxaliplatin combination) plus BEV, based on a subgroup analysis of the TRIBE study. In this analysis of 16 mCRC pts with BRAF-mut tumors, median PFS (mPFS) and OS (mOS) were 7.5 and 19 months (mo), respectively. Since the impact of 3-CT plus CET on outcomes in pts with BRAF-mut tumors is largely unexplored, we aimed to assess this subpopulation in the METHEP2 trial. Methods: This trial assessed whether 3-CT (FOLFIRINOX) compared to 2-CT (FOLFOX or FOLFIRI), combined with CET or BEV (by KRAS exon 2/RAS status), would increase R0/R1 liver resection rates in pts with initially CRLM. As an exploratory analysis, we assessed the outcome of the subset of BRAF-mut mCRC pts. Results: 256 pts were included. KRAS exon 2 and RAS (KRAS/NRAS: exon 2, exon 3, exon 4) were mutated in 91/256 pts (35.5%) and in 109/218 pts (50%), respectively. The R0/R1 liver resection rate was 57% in the 3-CT arm vs. 48% in the 2-CT arm. mPFS was 12.8 mo in the 3-CT arm vs. 11.5 mo in the 2-CT arm (HR, 1.05; 95%CI, 0.79-1.39). mOS was 42.9 mo in the 3-CT arm vs. 37.6 mo in the 2-CT arm (HR, 0.80; 95%CI, 0.56-1.16). Nine out of 230 (3.9%) mCRC pts were BRAF-mut: 8/9 pts received CET and 1 (in the 2-CT arm) received BEV as the targeted agent. Efficacy results in the 2-CT (n = 4) vs. the 3-CT (n = 5) arms were as follows: objective tumor response, 0/4 vs. 4/5; R0/R1 resection, 0/4 vs. 2/5; mPFS, 1.8 vs. 6.1 mo; and mOS, 6.6 vs. 21.3 mo. Conclusions: In this small series, pts with BRAF-mut tumors treated with 3-CT plus a targeted agent had better PFS and OS than those treated with 2-CT plus a targeted agent. Moreover, intent-to-treat survival outcomes with 3-CT plus CET are in the same range than those with 3-CT plus BEV from TRIBE. Clinical trial information: NCT01442935

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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

NCT01442935

Citation

J Clin Oncol 36, 2018 (suppl; abstr 3548)

DOI

10.1200/JCO.2018.36.15_suppl.3548

Abstract #

3548

Poster Bd #

41

Abstract Disclosures