Jocelin Huang1, Suresh G Nair2, Michelle R Mahoney3, Garth D Nelson3, Anthony F Shields4, Emily Chan5, Richard M Goldberg6, Sharlene Gill7, Morton S Kahlenberg8, James T Quesenberry9, Stephen N Thibodeau1, Thomas C Smyrk1, Axel Grothey1, Frank A Sinicrope1, Thomas A Webb10, Gist H Farr11, Barbara A Pockaj12, Jeffrey L Berenberg13, Margaret Mooney14, Daniel J Sargent3, Steven R Alberts15. 1. Department of Oncology, Mayo Clinic Rochester, Rochester, MN. 2. Lehigh Valley Hospital, Allentown, PA. 3. Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN. 4. Department of Oncology, Karmanos Cancer Institute, Detroit, MI. 5. Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN. 6. Department of Oncology, The Ohio State University Wexner Medical Center, Columbus, OH. 7. Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. 8. Surgical Oncology Associates of South Texas, San Antonio, TX. 9. Siouxland Hematology Oncology Associates, Sioux City, IA. 10. Illinois Oncology Research Association Community Clinical Oncology Program, Peoria, IL. 11. Ochsner Community Clinical Oncology Program, New Orleans, LA. 12. Mayo Clinic Arizona, Scottsdale, AZ. 13. University of Hawaii Cancer Center Community Clinical Oncology Program, Honolulu, HI. 14. Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD. 15. Department of Oncology, Mayo Clinic Rochester, Rochester, MN. Electronic address: alberts.steven@mayo.edu.
Abstract
BACKGROUND: Two arms with FOLFIRI, with or without cetuximab, were initially included in the randomized phase III intergroup clinical trial NCCTG (North Central Cancer Treatment Group) N0147. When other contemporary trials demonstrated no benefit to using irinotecan as adjuvant therapy, the FOLFIRI-containing arms were discontinued. We report the clinical outcomes for patients randomized to FOLFIRI with or without cetuximab. PATIENTS AND METHODS: After resection, patients were randomized to 12 biweekly cycles of FOLFIRI, with or without cetuximab. KRAS (Kirsten rat sarcoma viral oncogene homolog) mutation status was retrospectively determined in a central lab. The primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS) and toxicity. RESULTS: One hundred and six patients received FOLFIRI and 40 received FOLFIRI plus cetuximab. Median follow-up was 5.95 years (range, 0.1-7.0 years). The addition of cetuximab showed a trend toward improved DFS (hazard ratio [HR], 0.53; 95% CI, 0.26-1.1; P = .09) and OS (HR, 0.45; 95% CI, 0.17-1.16; P = .10) in the overall group, regardless of KRAS status, and in patients with wild type KRAS. Grade ≥ 3 nonhematologic adverse effects were significantly increased in the cetuximab versus FOLFIRI-alone arm (68% vs. 46%; P = .02). Adjuvant FOLFIRI resulted in a 3-year DFS less than that expected for FOLFOX. CONCLUSION: In this small randomized subset of patients with resected stage III colon cancer, the addition of cetuximab to FOLFIRI was associated with a nonsignificant trend toward improved DFS and OS. Nevertheless, considering the limitations of this analysis, FOLFOX without the addition of a biologic agent remains the standard of care for adjuvant therapy in resected stage III colon cancer.
RCT Entities:
BACKGROUND: Two arms with FOLFIRI, with or without cetuximab, were initially included in the randomized phase III intergroup clinical trial NCCTG (North Central Cancer Treatment Group) N0147. When other contemporary trials demonstrated no benefit to using irinotecanas adjuvant therapy, the FOLFIRI-containing arms were discontinued. We report the clinical outcomes for patients randomized to FOLFIRI with or without cetuximab. PATIENTS AND METHODS: After resection, patients were randomized to 12 biweekly cycles of FOLFIRI, with or without cetuximab. KRAS (Kirsten rat sarcoma viral oncogene homolog) mutation status was retrospectively determined in a central lab. The primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS) and toxicity. RESULTS: One hundred and six patients received FOLFIRI and 40 received FOLFIRI plus cetuximab. Median follow-up was 5.95 years (range, 0.1-7.0 years). The addition of cetuximab showed a trend toward improved DFS (hazard ratio [HR], 0.53; 95% CI, 0.26-1.1; P = .09) and OS (HR, 0.45; 95% CI, 0.17-1.16; P = .10) in the overall group, regardless of KRAS status, and in patients with wild type KRAS. Grade ≥ 3 nonhematologic adverse effects were significantly increased in the cetuximab versus FOLFIRI-alone arm (68% vs. 46%; P = .02). Adjuvant FOLFIRI resulted in a 3-year DFS less than that expected for FOLFOX. CONCLUSION: In this small randomized subset of patients with resected stage III colon cancer, the addition of cetuximab to FOLFIRI was associated with a nonsignificant trend toward improved DFS and OS. Nevertheless, considering the limitations of this analysis, FOLFOX without the addition of a biologic agent remains the standard of care for adjuvant therapy in resected stage III colon cancer.
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