Modified FOLFOXIRI With or Without Cetuximab as Conversion Therapy in Patients with RAS/BRAF Wild-Type Unresectable Liver Metastases Colorectal Cancer: The FOCULM Multicenter Phase II Trial
| Autor: | Huabin Hu, Jianwei Zhang, Yonghua Cai, Hui Wang, Kun Wang, Wei Wang, Yan Huang, Zhiyang Zhou, Shuangling Luo, Li Ling, Ping Lan, Zehua Wu, Tenghui Ma, Jiayu Ling, Yunle Wan, Xiaojian Wu, Yue Cai, Haibo Zhang, Jiaming Zhou, Fangqian Li, Rongbo Lin, Ming Liu, Yanhong Deng, Liang Kang, Guang-Jian Liu, Meng Qiu, Meijin Huang, Huaiming Wang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Proto-Oncogene Proteins B-raf Cancer Research medicine.medical_specialty China Organoplatinum Compounds Colorectal cancer Leucovorin Cetuximab Gastroenterology 03 medical and health sciences Folinic acid 0302 clinical medicine Internal medicine Antineoplastic Combined Chemotherapy Protocols Gastrointestinal Cancer medicine Clinical endpoint Humans neoplasms FOLFOXIRI business.industry Liver Neoplasms medicine.disease digestive system diseases Oxaliplatin Irinotecan Regimen 030104 developmental biology Oncology 030220 oncology & carcinogenesis Camptothecin Fluorouracil business Colorectal Neoplasms medicine.drug |
| Zdroj: | Oncologist |
| ISSN: | 1549-490X |
| Popis: | Purpose This trial evaluated the addition of cetuximab to a modified FOLFOXIRI (mFOLFOXIRI: 5-fluorouracil/folinic acid, oxaliplatin, irinotecan) as conversion therapy in a two-group, nonrandomized, multicenter, phase II trial in patients with initially technically unresectable colorectal liver-limited metastases (CLM) and BRAF/RAS wild-type. Patients and Methods Patients were enrolled to receive cetuximab (500 mg/m2) plus mFOLFOXIRI (oxaliplatin 85 mg/m2, irinotecan 165 mg/m2, folinic acid 400 mg/m2, 5-fluorouracil 2,800 mg/m2 46-hour infusion, every 2 weeks) (the cetuximab group) or the same regimen of mFOLFOXIRI alone (the control group), in a 2:1 ratio allocation. The primary endpoint was the rate of no evidence of disease (NED) achieved. Secondary endpoints included resection rate, objective response rate (ORR), survival, and safety. Results Between February 2014 and July 2019, 117 patients were registered for screening at six centers in China, and 101 of these were enrolled (67 cetuximab group, 34 control group). The rate of NED achieved was 70.1% in the cetuximab group and 41.2% in the control group (difference 29.0%; 95% confidence interval [CI], 9.1%–48.8%; p = .005). Patients in the cetuximab group had improved ORR (95.5% vs. 76.5%; difference 19.1%; 95% CI, 17.4%–36.4%; p = .010) compared with those in control group. Progression-free survival and overall survival showed the trend to favor the cetuximab group. The incidence of grade 3 and 4 adverse events was similar in the two groups. Conclusion Addition of cetuximab to mFOLFOXIRI improved the rate of NED achieved. This combination could be an option of conversion regimen for molecularly selected patients with initially technically unresectable CLM. Implications for Practice This trial evaluated the addition of cetuximab to a modified FOLFOXIRI as conversion therapy in a phase II trial in patients with initially technically unresectable colorectal liver-limited metastases and BRAF/RAS wild-type. The rate of no evidence of disease achieved was 70.1% in the cetuximab plus modified FOLFOXIRI group and 41.2% in the modified FOLFOXIRI group. Objective response rates, overall survival, and progression-free survival were improved in the cetuximab group when compared with the modified FOLFOXIRI group. Addition of cetuximab to modified FOLFOXIRI increased the rate of no evidence of disease achieved, and this combination could be an option of conversion regimen for molecularly selected patients with initially technically unresectable colorectal liver-limited metastasis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text