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Published in: Journal of Cancer Research and Clinical Oncology 1/2012

01-01-2012 | Original Paper

First-line panitumumab plus irinotecan/5-fluorouracil/leucovorin treatment in patients with metastatic colorectal cancer

Authors: Claus-Henning Köhne, Ralf Hofheinz, Laurent Mineur, Henry Letocha, Richard Greil, Josef Thaler, Eva Fernebro, Erick Gamelin, Lucy DeCosta, Meinolf Karthaus

Published in: Journal of Cancer Research and Clinical Oncology | Issue 1/2012

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Abstract

Purpose

Panitumumab monotherapy is approved for KRAS wild-type (WT) metastatic colorectal cancer (mCRC) progressing after standard chemotherapy. This study evaluated first-line panitumumab plus FOLFIRI in patients with mCRC.

Methods

In this phase II, single-arm study, panitumumab (6 mg/kg) and FOLFIRI [irinotecan (180 mg/m2) and leucovorin (400 mg/m2) followed by a 5-fluorouracil 400 mg/m2 bolus and a 2,400–3,000 mg/m2 continuous infusion] were administered every 14 days until progression. Data were analysed descriptively overall and by tumour KRAS status.

Results

KRAS data were available for 145/154 (94%) patients: 59% KRAS WT and 41% mutant (MT); mean follow-up was 39.5 versus 35.8 weeks, respectively. Objective responses occurred in 49% of patients: 56% versus 38% in the KRAS WT versus MT groups [(18% difference (95% CI 1–35%); odds ratio 2.1 (95% CI 1.0–4.4)]; median duration of response was 13.0 versus 7.4 months. More patients in the WT group underwent R0 resection (8% vs. 5%); median progression-free survival also favoured this group (8.9 vs. 7.2 months). The most common adverse events (any grade) were integument toxicities (98%), diarrhoea (79%) and stomatitis/oral mucositis (51%).

Conclusions

As expected, consistently favourable efficacy was observed in patients with KRAS WT versus MT tumours receiving first-line panitumumab plus FOLFIRI treatment.
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Literature
go back to reference Benvenuti S, Sartore-Bianchi A, Di Nicolantonio F et al (2007) Oncogenic activation of the RAS/RAF signaling pathway impairs the response of metastatic colorectal cancers to anti-epidermal growth factor receptor antibody therapies. Cancer Res 67:2643–2648. doi:10.1158/0008-5472.CAN-06-4158 PubMedCrossRef Benvenuti S, Sartore-Bianchi A, Di Nicolantonio F et al (2007) Oncogenic activation of the RAS/RAF signaling pathway impairs the response of metastatic colorectal cancers to anti-epidermal growth factor receptor antibody therapies. Cancer Res 67:2643–2648. doi:10.​1158/​0008-5472.​CAN-06-4158 PubMedCrossRef
go back to reference De Roock W, Piessevaux H, De Schutter J et al (2008) KRAS wild-type state predicts survival and is associated to early radiological response in metastatic colorectal cancer treated with cetuximab. Ann Oncol 19:508–515. doi:10.1093/annonc/mdm496 PubMedCrossRef De Roock W, Piessevaux H, De Schutter J et al (2008) KRAS wild-type state predicts survival and is associated to early radiological response in metastatic colorectal cancer treated with cetuximab. Ann Oncol 19:508–515. doi:10.​1093/​annonc/​mdm496 PubMedCrossRef
go back to reference Douillard JY, Cunningham D, Roth AD et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355:1041–1047. doi:10.1016/S0140-6736(00)02034-1 PubMedCrossRef Douillard JY, Cunningham D, Roth AD et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355:1041–1047. doi:10.​1016/​S0140-6736(00)02034-1 PubMedCrossRef
go back to reference Douillard JY, Siena S, Cassidy J et al (2010) Randomized, phase 3 study (PRIME) of panitumumab with FOLFOX4 versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 28:4697–4705. doi:10.1200/JCO.2009.27.4860 PubMedCrossRef Douillard JY, Siena S, Cassidy J et al (2010) Randomized, phase 3 study (PRIME) of panitumumab with FOLFOX4 versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 28:4697–4705. doi:10.​1200/​JCO.​2009.​27.​4860 PubMedCrossRef
go back to reference Freeman DJ, Juan T, Reiner M et al (2008) Association of K-ras mutational status and clinical outcomes in patients with metastatic colorectal cancer receiving panitumumab alone. Clin Colorectal Cancer 7:184–190. doi:10.3816/CCC.2008.n.024 PubMedCrossRef Freeman DJ, Juan T, Reiner M et al (2008) Association of K-ras mutational status and clinical outcomes in patients with metastatic colorectal cancer receiving panitumumab alone. Clin Colorectal Cancer 7:184–190. doi:10.​3816/​CCC.​2008.​n.​024 PubMedCrossRef
go back to reference Fuchs CS, Marshall J, Mitchell E et al (2007) Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C study. J Clin Oncol 25:4779–4786. doi:10.1200/JCO.2007.11.3357 PubMedCrossRef Fuchs CS, Marshall J, Mitchell E et al (2007) Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C study. J Clin Oncol 25:4779–4786. doi:10.​1200/​JCO.​2007.​11.​3357 PubMedCrossRef
go back to reference Kari C, Chan TO, Rocha de Quadros M, Rodeck U (2003) Targeting the epidermal growth factor receptor in cancer: apoptosis takes center stage. Cancer Res 63:1–5PubMed Kari C, Chan TO, Rocha de Quadros M, Rodeck U (2003) Targeting the epidermal growth factor receptor in cancer: apoptosis takes center stage. Cancer Res 63:1–5PubMed
go back to reference Koo DH, Lee JL, Kim TW et al (2007) A Phase II study of cetuximab (Erbitux) plus FOLFIRI for irinotecan and oxaliplatin-refractory metastatic colorectal cancer. J Korean Med Sci 22(Suppl):S98–S103PubMedCrossRef Koo DH, Lee JL, Kim TW et al (2007) A Phase II study of cetuximab (Erbitux) plus FOLFIRI for irinotecan and oxaliplatin-refractory metastatic colorectal cancer. J Korean Med Sci 22(Suppl):S98–S103PubMedCrossRef
go back to reference Lièvre A, Bachet JB, Le Corre D et al (2006) KRAS mutation status is predictive of response to cetuximab therapy in colorectal cancer. Cancer Res 66:3992–3995PubMedCrossRef Lièvre A, Bachet JB, Le Corre D et al (2006) KRAS mutation status is predictive of response to cetuximab therapy in colorectal cancer. Cancer Res 66:3992–3995PubMedCrossRef
go back to reference Peeters M, Price T, Cervantes A et al (2010) Randomized phase 3 study of panitumumab with FOLFIRI versus FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol 28:4706–4713PubMedCrossRef Peeters M, Price T, Cervantes A et al (2010) Randomized phase 3 study of panitumumab with FOLFIRI versus FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol 28:4706–4713PubMedCrossRef
go back to reference Raoul JL, Van Laethem JL, Peeters M et al (2009) Cetuximab in combination with irinotecan/5-fluorouracil/folinic acid (FOLFIRI) in the initial treatment of metastatic colorectal cancer: a multicentre two-part phase I/II study. BMC Cancer 9:112. doi:10.1186/1471-2407-9-112 PubMedCrossRef Raoul JL, Van Laethem JL, Peeters M et al (2009) Cetuximab in combination with irinotecan/5-fluorouracil/folinic acid (FOLFIRI) in the initial treatment of metastatic colorectal cancer: a multicentre two-part phase I/II study. BMC Cancer 9:112. doi:10.​1186/​1471-2407-9-112 PubMedCrossRef
go back to reference Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914PubMedCrossRef Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914PubMedCrossRef
go back to reference Saltz LB, Meropol NJ, Loehrer PJ Sr, Needle MN, Kopit J, Mayer RJ (2004) Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol 22:1201–1208. doi:10.1200/JCO.2004.10.182 PubMedCrossRef Saltz LB, Meropol NJ, Loehrer PJ Sr, Needle MN, Kopit J, Mayer RJ (2004) Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol 22:1201–1208. doi:10.​1200/​JCO.​2004.​10.​182 PubMedCrossRef
go back to reference Sobrero AF, Maurel J, Fehrenbacher L et al (2008) EPIC: phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 26:2311–2319. doi:10.1200/JCO.2007.13.1193 PubMedCrossRef Sobrero AF, Maurel J, Fehrenbacher L et al (2008) EPIC: phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 26:2311–2319. doi:10.​1200/​JCO.​2007.​13.​1193 PubMedCrossRef
go back to reference Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216. doi:10.1093/jnci/92.3.205 PubMedCrossRef Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216. doi:10.​1093/​jnci/​92.​3.​205 PubMedCrossRef
go back to reference Van Cutsem E, Peeters M, Siena S et al (2007) Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 25:1658–1664. doi:10.1200/JCO.2006.08.1620 PubMedCrossRef Van Cutsem E, Peeters M, Siena S et al (2007) Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 25:1658–1664. doi:10.​1200/​JCO.​2006.​08.​1620 PubMedCrossRef
Metadata
Title
First-line panitumumab plus irinotecan/5-fluorouracil/leucovorin treatment in patients with metastatic colorectal cancer
Authors
Claus-Henning Köhne
Ralf Hofheinz
Laurent Mineur
Henry Letocha
Richard Greil
Josef Thaler
Eva Fernebro
Erick Gamelin
Lucy DeCosta
Meinolf Karthaus
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Journal of Cancer Research and Clinical Oncology / Issue 1/2012
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-011-1061-6

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