Efficacy of continued cetuximab for unresectable metastatic colorectal cancer after disease progression during first-line cetuximab-based chemotherapy: a retrospective cohort study
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Qingyang Feng1,*, Ye Wei1,*, Li Ren1,*, Peng Zheng1,*, Yiyi Yu2, Qinghai Ye3, Jianyong Ding4, Jingwen Chen1, Wenju Chang1, Yunshi Zhong1, Dexiang Zhu1, Qi Lin1, Liangliang Yang1, Xinyu Qin1, Jianmin Xu1
1Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
3Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
4Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
*These authors contributed equally to this work
Jianmin Xu, e-mail: firstname.lastname@example.org
Keywords: colorectal cancer, metastasis, cetuximab, cross-line treatment, early tumor shrinkage
Received: September 11, 2015 Accepted: January 23, 2016 Published: February 04, 2016
This study assessed second-line continued use of cetuximab for treatment of unresectable metastatic colorectal cancer (mCRC) after disease progression during first-line cetuximab-based therapy. Consecutive patients with wild-type KRAS exon 2 and unresectable mCRC were retrospectively enrolled after disease progression during first-line cetuximab-based chemotherapy. Second-line continued cetuximab plus changed chemotherapy (cetuximab continuation group, n = 102) was compared with changed chemotherapy only (chemotherapy only group, n = 96) with respect to treatment efficacy and safety endpoints. NRAS and other KRAS genotypes were also detected as a post hoc analysis. The cetuximab continuation group showed better progression-free survival (median, 6.3 vs. 4.5 months, P = 0.004), overall survival (median, 17.3 vs. 14.0 months, P < 0.001) and disease control rate (70.6% vs. 53.1%, P = 0.011), and a potentially better overall response rate (18.6% vs. 9.4%, P = 0.062) than the chemotherapy only group. These benefits were seen mainly in patients with all RAS wild-type and exhibiting first-line early tumor shrinkage (ETS). For patients with other RAS mutations or who did not achieve first-line ETS, there was no difference between the two groups. These findings suggest that for patients with all RAS wild-type and unresectable mCRC who had disease progression during first-line cetuximab-based treatment, second-line continued cetuximab is effective. Moreover, ETS during first-line cetuximab-based treatment may be predictive of the efficacy of second-line continued cetuximab.
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