Phase III randomized sequential open-label study to evaluate the efficacy of FOLFOX + panitumumab followed by FOLFIRI + bevacizumab (Sequence 1) versus FOLFOX+ bevacizumab followed by FOLFIRI + panitumumab (Sequence 2) in untreated patients with wild-type RAS metastatic, primary left (L)-sided, unresectable colorectal cancer (CRC): The CR-SEQUENCE.

Authors

Ramon Salazar

Ramon Salazar

Oncobell Program IDIBELL Institut Català d'Oncologia Hospital Duran i Reynals, CIBERONC, Hospitalet, Spain

Ramon Salazar , Alfredo Carrato , Teresa Garcia Garcia , Javier Gallego Plazas , Auxiliadora Gómez-España , Cristina Gravalos Castro , M. Pilar Escudero , Maria Jose Safont , Antonieta Salud Salvia , Carles Pericay , Begoña Graña Suárez , David Marrupe , Rosario Vidal , Ferran Losa , Teresa Fernandez Rodriguez , Jose Luis Manzano Mozo , Josep Tabernero , Helder Mansinho , Clara Montagut , Enrique Aranda

Organizations

Oncobell Program IDIBELL Institut Català d'Oncologia Hospital Duran i Reynals, CIBERONC, Hospitalet, Spain, IRYCIS, CIBERONC, Alcalá University, Hospital Universitario Ramón y Cajal, Madrid, Spain, Hospital General Universitario Santa Lucía, Cartagena, Spain, Hospital General Universitario de Elche, Elche, Spain, IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain, Hospital Universitario 12 de Octubre, Madrid, Spain, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain, Hospital General Universitario de Valencia, Valencia, Spain, Hospital de Lleida Arnau de Vilanova, Lérida, Spain, Corporació Sanitària Parc Taulí, Sabadell, Spain, Complexo Hospitalario Universitario A Coruña, Coruña, Spain, Hospital Universitario de Móstoles, Móstoles, Spain, Hospital Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain, Hospital Sant Joan Despí - Moisés Broggi, Barcelona, Spain, Hospital Son Llatzer, Palma De Mallorca, Spain, Institut Català d'Oncologia, Hospital Universitario Germans Trias i Pujol, Badalona, Spain, Vall d'Hebron University Hospital, CIBERONC, Barcelona, Spain, GICD- Hospital Garcia de Orta, ., Portugal, Hospital del Mar Medical Research Institute, CIBERONC, Barcelona, Spain

Research Funding

Pharmaceutical/Biotech Company

Background: Both anti-EGFR and anti-VEGF therapies have shown clinical benefit when they are added in first and second-line in L-sided CRC. The conflicting results in anti-VEGF vs. anti-EGFR studies (FIRE-3, PEAK and CALGB/SWOG 80405 studies) suggest that the sequence of targeted therapies added to FOLFOX or FOLFIRI regimens in first- and second-line treatment could be an important factor in the overall survival (OS) of mCRC patients. Currently, there are no randomized data on the sequential use of an anti-EGFR followed by an anti-VEGF or vice versa. Therefore, the aim of this randomized clinical trial is to compare the efficacy of two treatment sequences, panitumumab followed by bevacizumab versus bevacizumab followed by panitumumab in combination with FOLFOX chemotherapy in first-line and with FOLFIRI in second-line in patients with wild-type RAS, primary L-sided, metastatic colorectal cancer (mCRC). Methods: A phase III, multicentre, open-label and randomized two-arm clinical trial. Untreated patients with wild-type RAS mCRC (determined locally), primary L-sided and unresectable will be screened for this trial. Eligible patients will be randomized 1:1 to receive first-line (1L) panitumumab plus FOLFOX and then bevacizumab plus FOLFIRI as second-line (2L) treatment (Seq. 1) or bevacizumab plus FOLFOX as 1L and then panitumumab plus FOLFIRI as 2L treatment (Seq. 2). Randomization will be stratified by number of metastatic organs involved (1 vs > 1). Primary objective is the comparison of the progression free survival (PFS) rate at 35 months (m) of Seq 1 vs Seq. 2. Secondary objectives: PFS from randomization to 2nd progression or death, OS rate at 35 months and OS of Seq. 1 vs Seq. 2; PFS, objective response rate, disease control rate, early tumour shrinkage, Depth of Response, duration and time to response and safety in 1L treatment and in 2L treatment in each Sequence arm. Exploratory objectives: impact of baseline biomarkers predictive of the efficacy in each Sequence arm and the clinical impact of clonal dynamics by longitudinal analysis of circulating tumour deoxyribonucleic acid (ctDNA) in plasma. The trial is in progress; 28 of up to 370 planned patients have been recruited at the end of January 2019 (first patient in 31 October 2018). Clinical trial information: NCT03635021

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Abstract Details

Meeting

2019 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

NCT03635021

Citation

J Clin Oncol 37, 2019 (suppl; abstr TPS3618)

DOI

10.1200/JCO.2019.37.15_suppl.TPS3618

Abstract #

TPS3618

Poster Bd #

108b

Abstract Disclosures