PURPOSE: To determine whether second-line therapy with capecitabine and temozolomide was superior to irinotecan, leucovorin, and fluorouracil (FOLFIRI) in patients with RAS-mutated, methyl-guanine methyltransferase (MGMT)-methylated metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: In this randomized, phase II trial, we enrolled patients with RAS-mutated, MGMT-methylated mCRC after failure of oxaliplatin-based regimen. Patients with centrally confirmed MGMT methylation were stratified by first-line progression-free survival (PFS) and prior bevacizumab and randomized to either capecitabine plus temozolomide (arm A, CAPTEM) or FOLFIRI (arm B). The primary endpoint was PFS analyzed on intention-to-treat basis, with 90% power and one-sided significance level of 0.05 to detect an increase of median time from 2 months in arm B to 4 months in arm A. RESULTS: Between November 2014 and May 2019, 86 patients were randomly assigned to arm A (n = 43) or arm B (n = 43). After a median follow-up of 30.5 months (interquartile range, 12.2-36.3), 79 disease progression or death events occurred. Superiority of arm A was not demonstrated (one-sided P = 0.223). Progression-free survival and overall survival were 3.5 (2.0-5.0) and 9.5 (8.2-25.8) in arm A versus 3.5 (2.3-6.1) and 10.6 (8.5-20.8) in arm B [HR = 1.19 (0.82-1.72) and HR = 0.97 (0.58-1.61)], respectively. Grade ≥3 treatment-related adverse events had higher incidence in arm B versus A (47.6% vs 16.3%), and quality of life was significantly worse in arm B. Patients with positive MGMT expression by IHC did not benefit from CAPTEM. CONCLUSIONS: Temozolomide-based therapy warrants further investigation in molecularly hyperselected subgroups.
Capecitabine and Temozolomide versus FOLFIRI in RAS-Mutated, MGMT-Methylated Metastatic Colorectal Cancer / F. Pietrantonio, R. Lobefaro, M. Antista, S. Lonardi, A. Raimondi, F. Morano, S. Mosconi, L. Rimassa, S. Murgioni, A. Sartore-Bianchi, G. Tomasello, R. Longarini, G. Farina, F. Petrelli, S. Gori, G. Randon, S. Corallo, F. Pagani, V. Guarini, F. Palermo, A. Martinetti, M. Macagno, L. Barault, F. Perrone, E. Tamborini, M. Milione, F. Di Nicolantonio, M. Di Maio, G. Fucà, M. Di Bartolomeo, F. de Braud. - In: CLINICAL CANCER RESEARCH. - ISSN 1078-0432. - (2019). [Epub ahead of print]
Titolo: | Capecitabine and Temozolomide versus FOLFIRI in RAS-Mutated, MGMT-Methylated Metastatic Colorectal Cancer |
Autori: | LOBEFARO, RICCARDO (Secondo) DE BRAUD, FILIPPO GUGLIELMO MARIA (Ultimo) |
Settore Scientifico Disciplinare: | Settore MED/06 - Oncologia Medica |
Data di pubblicazione: | 2019 |
Rivista: | |
Tipologia: | Article (author) |
Data ahead of print / Data di stampa: | 18-nov-2019 |
Digital Object Identifier (DOI): | http://dx.doi.org/10.1158/1078-0432.CCR-19-3024 |
Appare nelle tipologie: | 01 - Articolo su periodico |
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