Phase III FIRE-4 study (AIO KRK-0114): Influence of baseline liquid biopsy results in first-line treatment efficacy of FOLFIRI/cetuximab in patients with tissue RAS-WT mCRC.

Authors

Sebastian Stintzing

Sebastian Stintzing

Medical Department, Division of Hematology, Oncology, and Cancer Immunology (CCM), Charité Universitätsmedizin Berlin, Berlin, Germany

Sebastian Stintzing , Volker Heinemann , Ludwig Fischer von Weikersthal , Martin Fuchs , Florian Kaiser , Kathrin Heinrich , Dominik Paul Modest , Ralf Dieter Hofheinz , Thomas Decker , Armin Gerger , Stefan Angermeier , Holger Rumpold , Leopold Öhler , Birgit Gruenberger , Dora Niedersuess-Beke , Thomas Winder , Joerg Trojan , Gerald W. Prager , Alexander Baraniskin , Susanne Klein-Scory

Organizations

Medical Department, Division of Hematology, Oncology, and Cancer Immunology (CCM), Charité Universitätsmedizin Berlin, Berlin, Germany, Comprehensive Cancer Center at Ludwig Maximilian University of Munich, Munich, Germany, MVZ Gesundheitszentrum St. Marien GmbH, Amberg, Germany, München Klinik Bogenhausen, Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Munich, Germany, VK&K Studienzentrum, Landshut, Germany, Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, 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, Department of Medicine III, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany, Onkologie Ravensburg, Ravensburg, Germany, Medical University of Graz, Graz, Austria, Klinikum Ludwigsburg, Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Pneumologie, Diabetologie und Infektiologie, Ludwigsburg, Germany, Medical University of Innsbruck, Innsbruck, Austria, Department of Internal Medicine/Oncology, St. Joseph Hospital, Vienna, Austria, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria, Wilhelminenspital, Vienna, Austria, Department of Internal Medicine II, Divison of Oncology/Hematology, Hospital Feldkirch, Feldkirch, Austria, Klinikum der Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany, Medical University of Vienna, Vienna, Austria, EVK Hamm, Hamm, Germany, Department of Hematology and Oncology, Knappschaftskrankenhaus Ruhr University Bochum, Bochum, Germany

Research Funding

Institutional Funding
Merck

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, arm A patients continued FOLFIRI/Cet until progression or intolerable toxicity. In arm B, patients received FOLFIRI/Cet for 8-12 cycles, after which maintenance therapy with 5-FU/FA plus bevacizumab (5-FU/Bev) was applied. The first randomization evaluates the question if an early switch from cetuximab to bevacizumab may prolong PFS. Within the translational protocol, serial baseline liquid biopsy were taken to analyze RAS and BRAF mutations. Methods: Within this randomized, controlled, open-label phase-III study, patients received FOLFIRI (irinotecan plus 5-FU/FA) plus cetuximab at the standard dosing schedule. In arm A, FOLFIRI plus cetuximab was continued until progression or intolerable toxicity. 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 5-FU/FA plus bevacizumab (5mg/kg) until disease progression or intolerable toxicity. Overall survival after second randomization (part 2) is evaluated as a primary endpoint. Liquid Biopsies were analyzed by RAS BEAMing and BRAF ddPCR technology. Results: From August 2015 to January 2021, 673 patients were randomized, and liquid biopsies of 540 patients were evaluable at baseline. Of those, 70 (13%) were RAS mutant and 38 (7%) BRAFV600E mutant at baseline. Patients with a detectable RASmut had a significant shorter PFS and OS when compared to RASwt patients (PFS: 9.0mo vs. 11.5mo; p < 0.001; OS: 22.1mo vs 33.6mo; p < 0.001). Whereas, for RASwt patients no difference for both arms with respect to PFS and OS could be observed, RASmut patients (n = 70) had a clear trend towards shorter survival in the standard FOLFIRI cetuximab arm (PFS: 6.4mo vs. 10.1mo, p = 0.54; OS: 24.9mo vs. 16.3mo, p = 0.10). Patients with a BRAF mutation in liquid biopsy had median survival times as expected for BRAF mutant patients (PFS = 5.5mo; OS = 12.0mo). In the standard arm, with a continuous administration of cetuximab, the conversion rate from RASwt to RASmut was significantly higher at progression than in the switch maintenance arm. Conclusions: Liquid biopsy detected RAS mutation in 13% of patients deemed RASwt based on tissue analyses. These patients show outcome characteristics expected for RAS mutant patients (median PFS of 9.0 months and median OS of 22 months). The study thus shows the clinical relevance of liquid biopsy in the verification of RAS mutational status. Clinical trial information: NCT02934529.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Oral Abstract Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Clinical Trial Registration Number

NCT02934529

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 3507)

DOI

10.1200/JCO.2023.41.16_suppl.3507

Abstract #

3507

Abstract Disclosures