Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer
Abstract Purpose Combination of biological therapy and chemotherapy improves the survival of patients with metastatic colorectal cancer (mCRC). However, the optimal biological therapy sequence remains unclear. In this retrospective study, we evaluated the clinical outcomes of patients with mCRC trea...
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Wiley
2019-07-01
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Series: | Cancer Medicine |
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Online Access: | https://doi.org/10.1002/cam4.2235 |
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author | Hung‐Chih Hsu Yu‐Chun Liu Chuang‐Wei Wang Wen-Chi Chou Yu-Jen Hsu Jy-Ming Chiang Yung-Chang Lin Tsai-Sheng Yang |
author_facet | Hung‐Chih Hsu Yu‐Chun Liu Chuang‐Wei Wang Wen-Chi Chou Yu-Jen Hsu Jy-Ming Chiang Yung-Chang Lin Tsai-Sheng Yang |
author_sort | Hung‐Chih Hsu |
collection | DOAJ |
description | Abstract Purpose Combination of biological therapy and chemotherapy improves the survival of patients with metastatic colorectal cancer (mCRC). However, the optimal biological therapy sequence remains unclear. In this retrospective study, we evaluated the clinical outcomes of patients with mCRC treated with different sequences of biological therapies as first‐ and third‐line therapy. Methods We only included patients with wild‐type KRAS exon 2 mCRC who had received cetuximab, bevacizumab, and standard chemotherapy. The patients were treated with cetuximab or bevacizumab as first‐ or third‐line therapy combined with a similar chemotherapy backbone. Results In total, 102 patients were included. Forty‐six patients received first‐line cetuximab therapy followed by third‐line bevacizumab therapy (cetuximab → bevacizumab group) and 56 patients received first‐line bevacizumab therapy followed by third‐line cetuximab therapy (bevacizumab → cetuximab group). The cetuximab → bevacizumab group was associated with increased survival (OS) compared with the bevacizumab → cetuximab group (median OS: 30.4 months vs 25.7 months, hazard ratio (HR): 0.55, 95% confidence interval (CI): 0.36‐0.86). When calculated from the start of second‐ and third‐line therapies, OS was also higher in the cetuximab → bevacizumab group (second‐line: 20.6 months vs 14.8 months, HR: 0.54, 95% CI: 0.34‐0.81; third‐line: 12.5 months vs 9.9 months, HR: 0.53, 95% CI: 0.35‐0.83). The cetuximab → bevacizumab group was also associated with better progression‐free survival than the bevacizumab → cetuximab group (8.8 vs 4.5 months, HR: 0.43, 95% CI: 0.25‐0.58) in the third‐line setting, but not in the first‐ or second‐line settings. Conclusions Our study demonstrated that first‐line cetuximab therapy followed by third‐line bevacizumab therapy was associated with favorable clinical outcomes as compared to the reverse sequence. |
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format | Article |
id | doaj.art-66d815ddf4d5467198a4d00f0ed001b9 |
institution | Directory Open Access Journal |
issn | 2045-7634 |
language | English |
last_indexed | 2024-12-10T07:53:42Z |
publishDate | 2019-07-01 |
publisher | Wiley |
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spelling | doaj.art-66d815ddf4d5467198a4d00f0ed001b92022-12-22T01:56:57ZengWileyCancer Medicine2045-76342019-07-01873437344610.1002/cam4.2235Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancerHung‐Chih Hsu0Yu‐Chun Liu1Chuang‐Wei Wang2Wen-Chi Chou3Yu-Jen Hsu4Jy-Ming Chiang5Yung-Chang Lin6Tsai-Sheng Yang7Division of Hematology‑Oncology Chang Gung Memorial Hospital at Linkou Taoyuan TaiwanCollege of Medicine Chang Gung University Taoyuan TaiwanDepartment of Dermatology, Drug Hypersensitivity Clinical and Research Center Chang Gung Memorial Hospitals Taipei TaiwanDivision of Hematology‑Oncology Chang Gung Memorial Hospital at Linkou Taoyuan TaiwanCollege of Medicine Chang Gung University Taoyuan TaiwanCollege of Medicine Chang Gung University Taoyuan TaiwanDivision of Hematology‑Oncology Chang Gung Memorial Hospital at Linkou Taoyuan TaiwanDivision of Hematology‑Oncology Chang Gung Memorial Hospital at Linkou Taoyuan TaiwanAbstract Purpose Combination of biological therapy and chemotherapy improves the survival of patients with metastatic colorectal cancer (mCRC). However, the optimal biological therapy sequence remains unclear. In this retrospective study, we evaluated the clinical outcomes of patients with mCRC treated with different sequences of biological therapies as first‐ and third‐line therapy. Methods We only included patients with wild‐type KRAS exon 2 mCRC who had received cetuximab, bevacizumab, and standard chemotherapy. The patients were treated with cetuximab or bevacizumab as first‐ or third‐line therapy combined with a similar chemotherapy backbone. Results In total, 102 patients were included. Forty‐six patients received first‐line cetuximab therapy followed by third‐line bevacizumab therapy (cetuximab → bevacizumab group) and 56 patients received first‐line bevacizumab therapy followed by third‐line cetuximab therapy (bevacizumab → cetuximab group). The cetuximab → bevacizumab group was associated with increased survival (OS) compared with the bevacizumab → cetuximab group (median OS: 30.4 months vs 25.7 months, hazard ratio (HR): 0.55, 95% confidence interval (CI): 0.36‐0.86). When calculated from the start of second‐ and third‐line therapies, OS was also higher in the cetuximab → bevacizumab group (second‐line: 20.6 months vs 14.8 months, HR: 0.54, 95% CI: 0.34‐0.81; third‐line: 12.5 months vs 9.9 months, HR: 0.53, 95% CI: 0.35‐0.83). The cetuximab → bevacizumab group was also associated with better progression‐free survival than the bevacizumab → cetuximab group (8.8 vs 4.5 months, HR: 0.43, 95% CI: 0.25‐0.58) in the third‐line setting, but not in the first‐ or second‐line settings. Conclusions Our study demonstrated that first‐line cetuximab therapy followed by third‐line bevacizumab therapy was associated with favorable clinical outcomes as compared to the reverse sequence.https://doi.org/10.1002/cam4.2235anti‐EGFR/anti‐VEGFbiological therapy sequencemetastatic colorectal cancersurvival |
spellingShingle | Hung‐Chih Hsu Yu‐Chun Liu Chuang‐Wei Wang Wen-Chi Chou Yu-Jen Hsu Jy-Ming Chiang Yung-Chang Lin Tsai-Sheng Yang Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer Cancer Medicine anti‐EGFR/anti‐VEGF biological therapy sequence metastatic colorectal cancer survival |
title | Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer |
title_full | Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer |
title_fullStr | Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer |
title_full_unstemmed | Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer |
title_short | Sequential cetuximab/bevacizumab therapy is associated with improved outcomes in patients with wild‐type KRAS exon 2 metastatic colorectal cancer |
title_sort | sequential cetuximab bevacizumab therapy is associated with improved outcomes in patients with wild type kras exon 2 metastatic colorectal cancer |
topic | anti‐EGFR/anti‐VEGF biological therapy sequence metastatic colorectal cancer survival |
url | https://doi.org/10.1002/cam4.2235 |
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