M Michl1, S Stintzing2, L Fischer von Weikersthal3, T Decker4, A Kiani5, U Vehling-Kaiser6, S-E Al-Batran7, T Heintges8, C Lerchenmueller9, C Kahl10, G Seipelt11, F Kullmann12, M Stauch13, W Scheithauer14, J Hielscher15, M Scholz16, S Mueller17, M M Lerch18, D P Modest2, T Kirchner19, A Jung19, V Heinemann2. 1. Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich marlies.michl@med.uni-muenchen.de. 2. Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg. 3. Practice for Hematology and Medical Oncology, Gesundheitszentrum St Marien, Amberg. 4. Practice for Hematology and Medical Oncology, Onkonet-Onkologie Ravensburg, Ravensburg. 5. Department of Hematology and Medical Oncology, Klinik Herzoghöhe, Bayreuth. 6. Practice for Hematology and Medical Oncology, Landshut. 7. Department of Hematology and Medical Oncology, Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt. 8. Department of Gastroenterology and Oncology, Medical Department II, Lukaskrankenhaus, Städtisches Klinikum Neuss, Neuss. 9. Practice for Hematology and Medical Oncology, Muenster. 10. Department of Hematology and Medical Oncology, Klinikum Magdeburg, Magdeburg. 11. Practice for Hematology and Medical Oncology, Bad Soden. 12. Department of Gastroenterology, Hematology and Medical Oncology, Klinikum Weiden, Weiden. 13. Practice for Hematology and Medical Oncology, Kronach, Germany. 14. Department of Hematology and Medical Oncology, Medical University of Vienna, Vienna, Austria. 15. Department of Surgery, Klinikum Chemnitz, Chemnitz. 16. Department of Medicine, Klinikum Stuttgart, Stuttgart. 17. Practice for Hematology and Medical Oncology, Ansbach. 18. Department of Medicine A, University Medicine Greifswald, Greifswald. 19. Department of Pathology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg.
Abstract
BACKGROUND: To examine the relation of carcinoembryonic antigen (CEA) response with tumor response and survival in patients with (K)RAS wild-type metastatic colorectal cancer receiving first-line chemotherapy in the FIRE-3 trial comparingFOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab. PATIENTS AND METHODS: CEA response assessed as the percentage of CEA decrease from baseline to nadir was evaluated for its association with tumor response and survival. Receiver operating characteristic analysis revealed an optimal cut-off value of 75% using the maximum of sensitivity and specificity for CEA response to discriminate CEA responders from non-responders. In addition, the time to CEA nadir was calculated. RESULTS: Of 592 patients in the intent-to-treat population, 472 were eligible for analysis of CEA (cetuximab arm: 230 and bevacizumab arm: 242). Maximal relative CEA decrease (%) significantly (P = 0.003) differed between the cetuximab arm (median 83.0%; IQR 40.9%-94.7%) and the bevacizumab arm (median 72.3%; IQR 26.3%-91.0%). In a longitudinal analysis, the CEA decrease occurred faster in the cetuximab arm and was greater than in the bevacizumab arm at all evaluated time points until 56 weeks after treatment start. CEA nadir occurred after 3.3 months (cetuximab arm) and 3.5 months (bevacizumab arm), (P = 0.49). In the cetuximab arm, CEA responders showed a significantly longer progression-free survival [11.8 versus 7.4 months; hazard ratio (HR) 1.53; 95% Cl, 1.15-2.04; P = 0.004] and longer overall survival (36.6 versus 21.3 months; HR 1.73; 95% Cl, 1.24-2.43; P = 0.001) than CEA non-responders. Analysis of extended RAS wild-type patients revealed similar results. CONCLUSION: In the FIRE-3 trial, CEA decrease was significantly faster and greater in the cetuximab arm than in the bevacizumab arm and correlated with the prolonged survival observed in patients receiving FOLFIRI plus cetuximab. CLINICAL TRIALS NUMBER: NCT00433927 (ClinicalTrials.gov); AIO KRK0306 FIRE-3.
RCT Entities:
BACKGROUND: To examine the relation of carcinoembryonic antigen (CEA) response with tumor response and survival in patients with (K)RAS wild-type metastatic colorectal cancer receiving first-line chemotherapy in the FIRE-3 trial comparing FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab. PATIENTS AND METHODS: CEA response assessed as the percentage of CEA decrease from baseline to nadir was evaluated for its association with tumor response and survival. Receiver operating characteristic analysis revealed an optimal cut-off value of 75% using the maximum of sensitivity and specificity for CEA response to discriminate CEA responders from non-responders. In addition, the time to CEA nadir was calculated. RESULTS: Of 592 patients in the intent-to-treat population, 472 were eligible for analysis of CEA (cetuximab arm: 230 and bevacizumab arm: 242). Maximal relative CEA decrease (%) significantly (P = 0.003) differed between the cetuximab arm (median 83.0%; IQR 40.9%-94.7%) and the bevacizumab arm (median 72.3%; IQR 26.3%-91.0%). In a longitudinal analysis, the CEA decrease occurred faster in the cetuximab arm and was greater than in the bevacizumab arm at all evaluated time points until 56 weeks after treatment start. CEA nadir occurred after 3.3 months (cetuximab arm) and 3.5 months (bevacizumab arm), (P = 0.49). In the cetuximab arm, CEA responders showed a significantly longer progression-free survival [11.8 versus 7.4 months; hazard ratio (HR) 1.53; 95% Cl, 1.15-2.04; P = 0.004] and longer overall survival (36.6 versus 21.3 months; HR 1.73; 95% Cl, 1.24-2.43; P = 0.001) than CEA non-responders. Analysis of extended RAS wild-type patients revealed similar results. CONCLUSION: In the FIRE-3 trial, CEA decrease was significantly faster and greater in the cetuximab arm than in the bevacizumab arm and correlated with the prolonged survival observed in patients receiving FOLFIRI plus cetuximab. CLINICAL TRIALS NUMBER: NCT00433927 (ClinicalTrials.gov); AIO KRK0306 FIRE-3.