Metastatic colorectal cancer (mCRC) is treated with cetuximab 250 mg/m2 administered weekly over 1 hour or biweekly (q2w) over 3.5 hours when combined with irinotecan. This prospective study investigated cetuximab 500 mg/m2 plus irinotecan 180 mg/m2 administered q2w over 1.5 hours independent of RAS or BRAF mutation status in mCRC patients in a third-line setting. The intention-to-treat population included 181 patients. No patients had complete response, 18% had partial responses (PR) and 48% stable disease (SD). For cetuximab, a relative dose intensity of ≥90% was reached in 78% and for irinotecan in 67% of the patients. Grade 3-4 toxicities were pain (17%), fatigue (9%), neutropenia (8%), diarrhea (8%), rash (8%), infection (7%), hypersensitivity (3%). No deaths occurred. Next generation sequencing in 96.7% of the patients revealed that 50.3% had RAS and BRAFV600E wildtype (WT), with a mutation (MT) in 45.1% of the RAS and 4.4% of the BRAFV600E genes. In patients with RAS-WT and RAS-MT tumors, a PR was obtained in 32% and 4% (P = 0.000003) and a SD in 43% and 53%, respectively, with a superior PFS (6.2 vs. 3.7 months; hazard ratio (HR) 2.12, P = 0.00001) and OS (12.9 vs. 8.8 months; HR 1.71, P = 0.0008). Treatment efficacy was poor in 7.4% of patients with a RAS mutation outside KRAS exon 2 and in 38% of patients with KRAS exon 2 mutations. Administration of cetuximab and irinotecan q2w, shortening treatment time from 3.5 to 1.5 hours, is recommended as standard therapy. This article is protected by copyright. All rights reserved.
Keywords: cetuximab; colorectal cancer; irinotecan, RAS-mutation, bi-weekly.
This article is protected by copyright. All rights reserved.