Reinduction of an Anti-EGFR-based First-line Regimen in Patients with RAS Wild-type Metastatic Colorectal Cancer Enrolled in the Valentino Study. (25th January 2022)

• Record Type: Journal Article
• Authors: Fucà, Giovanni; Raimondi, Alessandra; Prisciandaro, Michele; Lonardi, Sara; Cremolini, Chiara; Ratti, Margherita; Clavarezza, Matteo; Murialdo, Roberto; Sartore-Bianchi, Andrea; Smiroldo, Valeria; Berenato, Rosa; Racca, Patrizia; Bergamo, Francesca; Corallo, Salvatore; Di Bartolomeo, Maria; de Braud, Filippo; Morano, Federica; Pietrantonio, Filippo
• Is Part Of: Oncologist. Volume 27:Number 1(2022)
• Page Start: e29
• Page End: e36
• Publication Date: 2022-01-25
• Subjects: metastatic colorectal cancer -- anti-EGFR -- reinduction -- chemotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1093/oncolo/oyab012
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: Background: In patients with RAS / BRAF wild-type metastatic colorectal cancer (mCRC), growing evidence supports anti-epidermal growth factor receptor (EGFR) retreatment, whereas little is known on the outcomes of anti-EGFR-based reinduction therapy during the upfront strategy. Methods: We included patients enrolled in the Valentino study who had disease progression and received at least one dose of post-progression therapy. The Kaplan–Meier method and Cox proportional hazards regression were used for the survival analysis. When comparing the outcomes of anti-EGFR-based reinduction versus any second line, a propensity score–based matching was used. Results: Liver-limited/single site of disease ( P < .001 and P = .002), left-sidedness ( P = .029), surgery of metastases ( P = .003), early tumor shrinkage, and deeper responses ( P = .018 and P = .036) were associated with the use of anti-EGFR-based reinduction versus any other second line. All patients treated with reinduction had an anti-EGFR-free interval of at least 3 months. In the propensity score–matched population, progression-free survival (PFS) was similar in the 2 treatment groups, the overall survival (OS) was significantly longer for patients treated with reinduction ( P = .029), and the response rate was higher in patients treated with reinduction ( P = .033). An oxaliplatin-free interval ≥12 months, left-sidedness, and molecular hyperselection beyond RAS/BRAF were associated with significantly better outcomes after anti-EGFR-based reinduction. Conclusions: Reinduction strategies with anti-EGFR-based regimens are commonly used in clinical practice. Our data highlight the importance of clinical–molecular selection for re-treatments and the need for prospective strategy trials in selected populations. Abstract : The optimal duration of an anti-EGFR-based first-line strategy is not well established for patients with RAS wild-type metastatic colorectal cancer (mCRC). This study assesses post-progression treatment outcomes in patients with RAS wild-type mCRC treated with initial FOLFOX-panitumumab followed by panitumumab-based maintenance in the frame of the Valentino trial.