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.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.

Reinduction of an Anti-EGFR-based First-line Regimen in Patients with RAS Wild-type Metastatic Colorectal Cancer Enrolled in the Valentino Study / G. Fucà, A. Raimondi, M. Prisciandaro, S. Lonardi, C. Cremolini, M. Ratti, M. Clavarezza, R. Murialdo, A. Sartore-Bianchi, V. Smiroldo, R. Berenato, P. Racca, F. Bergamo, S. Corallo, M. Di Bartolomeo, F. de Braud, F. Morano, F. Pietrantonio. - In: THE ONCOLOGIST. - ISSN 1083-7159. - 27:1(2022), pp. e29-e36. [10.1093/oncolo/oyab012]

Reinduction of an Anti-EGFR-based First-line Regimen in Patients with RAS Wild-type Metastatic Colorectal Cancer Enrolled in the Valentino Study

A. Raimondi
Secondo
;
M. Prisciandaro;A. Sartore-Bianchi;M. Di Bartolomeo;F. de Braud;F. Pietrantonio
Ultimo
2022

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.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.
anti-EGFR; chemotherapy; metastatic colorectal cancer; reinduction; Antineoplastic Combined Chemotherapy Protocols; Humans; Panitumumab; Prospective Studies; Proto-Oncogene Proteins B-raf; Colonic Neoplasms; Colorectal Neoplasms; Rectal Neoplasms
Settore MED/06 - Oncologia Medica
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/936249
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