Randomized study to investigate a switch maintenance concept with 5-FU plus bevacizumab after FOLFIRI plus cetuximab induction treatment versus continued treatment with FOLFIRI plus cetuximab: Report of a secondary endpoint of the phase-III FIRE-4 study (AIO KRK-0114).

Authors

Sebastian Stintzing

Sebastian Stintzing

Charité– Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology, and Cancer Immunology (CCM), Berlin, Germany

Sebastian Stintzing , Ludwig von Weikersthal , Martin Fuchs , Florian Kaiser , Kathrin Heinrich , Dominik Paul Modest , Ralf Hofheinz , Thomas Decker , Armin Gerger , Stefan Angermeier , Holger Rumpold , Andreas Dickhut , Leopold Öhler , Birgit Gruenberger , Dora Niedersuess -Beke , Matthias Sandmann , Thomas Winder , Stefan Kasper , Gerald Prager , Volker Heinemann

Organizations

Charité– Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology, and Cancer Immunology (CCM), Berlin, Germany, Gesundheitszentrum St. Marien GmbH, Amberg, Germany, München Klinik Bogenhausen, Department of Gastroenterology, Hepatology, and Gastrointestinal Oncology, Munich, Germany, University Clinic of Göttingen, Landshut, Germany, Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, München, Germany, Munich, Germany, Department of Hematology, Oncology and Cancer Immunology (CCM), Charité-Universtätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany, TagesTherapieZentrum TTZ, Edingen-Neckarhausen, Germany, Onkologie Ravensburg, Ravensburg, Germany, Medical University of Graz, Graz, Austria, Klinikum Ludwigsburg, Medizinische Klinik I, Ludwigsburg, Germany, Ordensklinikum Linz GmbH, Linz, Austria, Klinikum Fulda gAG, Fulda, Germany, Department of Internal Medicine/Oncology, St. Joseph Hospital, Vienna, Austria, Dept med Oncology, LKH Wr Neustadt, Wr Neustadt, Austria, Wiener Gesundheitsverbund, Wien, Ottakring, Austria, Petrus-Krankenhaus, Wuppertal, Germany, Landeskrankenhaus Feldkirch, Feldkirch, Austria, Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany, Medical University of Vienna, Vienna, Austria, University Hospital, LMU Munich, Department of Medicine III, and Comprehensive Cancer Center Munich, Munich, Germany

Research Funding

Pharmaceutical/Biotech Company

Background: FIRE-4 (AIO KRK-0114) is performed in RAS-wild-type (wt) mCRC patients. This randomized study tests the efficacy of early switch maintenance during 1st-line therapy (part 1) and re-challenge with cetuximab (part 2) in later-line treatment. In part 1, all patients received first-line induction treatment with FOLFIRI plus cetuximab (FOLFIRI/Cet). In arm A, patients were randomized to continue FOLFIRI/Cet until progression or intolerable toxicity. In arm B, patients received FOLFIRI/Cet for 8-12 cycles, after which maintenance therapy with Fluoropyrimidin plus bevacizumab was applied. The first randomization evaluates the question if an early switch from cetuximab to bevacizumab during maintenance therapy may prolong PFS. Methods: Within this randomized, controlled, open-label phase-III study, patients received FOLFIRI (irinotecan plus 5-FU/FA) plus cetuximab every two weeks at the standard dosing schedule. In arm A, FOLFIRI plus cetuximab was continued every 2 weeks until progression or intolerable toxicity. De- and re-escalation was allowed according to the local standard of care. In arm B, patients received 8 cycles of FOLFIRI plus cetuximab (in case of tumor response) or 12 cycles (in case of stable disease) followed by maintenance with Fluoropyrimidin plus bevacizumab (5mg/kg) every two weeks until disease progression or intolerable toxicity. Overall survival after second randomization (part 2) is evaluated as a primary endpoint. Here, we report PFS in first-line (part 1) as a secondary study endpoint of the study. Other secondary endpoints included ORR, OS, safety, and tolerability. Results: From August 2015 to January 2021, 672 patients were randomized and 656 patients were assigned to treatment in 120 German and 10 Austrian centers (327 arm A and 329 in arm B). PFS was comparable between both treatment arms (10.7 vs 11.3 months, HR 0.92 (95% CI: 0.76-1.10), p = 0.36). ORR in evaluable patients was not different and reached 75.7% and 72.3% with a DCR of 94.6% vs. 92.5% in the respective arms. Preliminary OS (≤40% of OS events recorded) was also similar between both arms (HR 1.030; p = 0.81). Updated results will be presented at the meeting. No new or unexpected toxicities were observed. Conclusion: Switch from FOLFIRI cetuximab to maintenance therapy with 5-FU plus bevacizumab did not induce superior efficacy (PFS, ORR, OS) compared to continued application of cetuximab. The results suggest that early switch maintenance from cetuximab to bevacizumab is not effective to postpone disease progression during targeted therapy. FIRE-4 confirms the efficacy of FOLFIRI plus cetuximab as first-line treatment of patients with RAS wild-type mCRC. Clinical trial information: NCT02934529.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer - Neo-Adjuvant/Adjuvant

Clinical Trial Registration Number

NCT02934529

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 3519)

DOI

10.1200/JCO.2022.40.16_suppl.3519

Abstract #

3519

Poster Bd #

313

Abstract Disclosures