Cetuximab and Chemotherapy as Initial Treatment for Metastatic Colorectal Cancer
| Autor: | György Bodoky, Paul Ruff, Eric Van Cutsem, Gunnar Folprecht, Claus Henning Köhne, Christopher Stroh, Michael Schlichting, Johannes Nippgen, Sabine Tejpar, J. Zaluski, Jae Kyung Roh, Tamás Pintér, Philippe Rougier, Erika Hitre, Geert R. D'Haens, A. Makhson, Robert Lim, Chung Rong Chang Chien |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Colorectal cancer Leucovorin Cetuximab Kaplan-Meier Estimate Antibodies Monoclonal Humanized medicine.disease_cause Young Adult Internal medicine Antineoplastic Combined Chemotherapy Protocols FOLFIRI Regimen medicine Humans Neoplasm Metastasis neoplasms Aged Aged 80 and over FOLFOXIRI business.industry Hazard ratio Antibodies Monoclonal General Medicine Middle Aged medicine.disease digestive system diseases ErbB Receptors Irinotecan Genes ras Mutation Disease Progression FOLFIRI Camptothecin Female Fluorouracil KRAS Colorectal Neoplasms business medicine.drug |
| Zdroj: | New England Journal of Medicine. 360:1408-1417 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa0805019 |
| Popis: | We investigated the efficacy of cetuximab plus irinotecan, fluorouracil, and leucovorin (FOLFIRI) as first-line treatment for metastatic colorectal cancer and sought associations between the mutation status of the KRAS gene in tumors and clinical response to cetuximab.We randomly assigned patients with epidermal growth factor receptor-positive colorectal cancer with unresectable metastases to receive FOLFIRI either alone or in combination with cetuximab. The primary end point was progression-free survival.A total of 599 patients received cetuximab plus FOLFIRI, and 599 received FOLFIRI alone. The hazard ratio for progression-free survival in the cetuximab-FOLFIRI group as compared with the FOLFIRI group was 0.85 (95% confidence interval [CI], 0.72 to 0.99; P=0.048). There was no significant difference in the overall survival between the two treatment groups (hazard ratio, 0.93; 95% CI, 0.81 to 1.07; P=0.31). There was a significant interaction between treatment group and KRAS mutation status for tumor response (P=0.03) but not for progression-free survival (P=0.07) or overall survival (P=0.44). The hazard ratio for progression-free survival among patients with wild-type-KRAS tumors was 0.68 (95% CI, 0.50 to 0.94), in favor of the cetuximab-FOLFIRI group. The following grade 3 or 4 adverse events were more frequent with cetuximab plus FOLFIRI than with FOLFIRI alone: skin reactions (which were grade 3 only) (in 19.7% vs. 0.2% of patients, P0.001), infusion-related reactions (in 2.5% vs. 0%, P0.001), and diarrhea (in 15.7% vs. 10.5%, P=0.008).First-line treatment with cetuximab plus FOLFIRI, as compared with FOLFIRI alone, reduced the risk of progression of metastatic colorectal cancer. The benefit of cetuximab was limited to patients with KRAS wild-type tumors. (ClinicalTrials.gov number, NCT00154102.) |
| Databáze: | OpenAIRE |
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