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Clinical Colorectal Cancer
Article . 2018 . Peer-reviewed
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Clinical Colorectal Cancer
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Final Analysis of Outcomes and RAS/BRAF Status in a Randomized Phase 3 Study of Panitumumab and Best Supportive Care in Chemorefractory Wild Type KRAS Metastatic Colorectal Cancer

Authors: Tae Won Kim; Anneli Elme; Joon Oh Park; Anghel Adrian Udrea; Sun Young Kim; Joong Bae Ahn; Ricardo Villalobos Valencia; +6 Authors

Final Analysis of Outcomes and RAS/BRAF Status in a Randomized Phase 3 Study of Panitumumab and Best Supportive Care in Chemorefractory Wild Type KRAS Metastatic Colorectal Cancer

Abstract

Tumor rat sarcoma gene (RAS) status is a negative predictive biomarker for anti-epidermal growth factor receptor (EGFR) therapy in metastatic colorectal cancer (mCRC). We analyzed outcomes according to RAS and v-Raf murine sarcoma viral oncogene homolog B (BRAF) mutational status, and evaluated early tumor shrinkage (ETS) and depth of response (DpR) for patients with wild type RAS.Patients with confirmed metastatic colon or rectum adenocarcinoma, wild type Kristen rat sarcoma gene tumor exon 2 status, clinical/radiologic disease progression or toxicity during irinotecan or oxaliplatin treatment, and no previous anti-EGFR therapy were randomized 1:1 to receive best supportive care (BSC) with or without panitumumab (6.0 mg/kg, intravenously, on day 1 of each 14-day cycle) in this open-label, multicenter, phase III study (20100007). RAS and BRAF mutation status were determined using Sanger sequencing. ETS was evaluated as maximum percentage change from baseline to week 8; DpR was calculated as the percentage change for tumor shrinkage at nadir versus baseline.Overall, 270 patients had RAS wild type mCRC (panitumumab with BSC, n = 142; BSC, n = 128). For patients with wild type RAS tumors, median overall survival (OS; hazard ratio [HR], 0.72; P = .015) and progression-free survival (PFS; HR, 0.45; P < .0001) were improved with panitumumab with BSC versus BSC. Similar improvements were seen for patients with wild type RAS, and wild type BRAF tumors (OS: HR, 0.75; P = .04; PFS: HR, 0.45; P < .0001). Median DpR was 16.9% for the evaluable panitumumab with BSC wild type RAS population. Overall, 69.5% experienced any type of tumor shrinkage at week 8; 38.2% experienced ≥ 20% shrinkage. Similar improvements in OS and PFS were seen with stratification according to ETS.This analysis showed that panitumumab improved outcomes in wild type RAS mCRC and indicated that ETS and DpR could be used as additional efficacy markers.

Keywords

Male, Drug Resistance, Anti-EGFR therapy ; Biomarkers ; Gastrointestinal cancer ; Randomized controlled trial ; Treatment outcome, Kaplan-Meier Estimate, Adenocarcinoma / pathology, Colorectal Neoplasms / genetics, Palliative Care*, Antineoplastic Combined Chemotherapy Protocols, 80 and over, Anti-EGFR therapy, Panitumumab / pharmacology, Prospective Studies, Colorectal Neoplasms / mortality, Irinotecan / therapeutic use, Treatment outcome, Infusions, Intravenous, Oxaliplatin / therapeutic use, Aged, 80 and over, Irinotecan / pharmacology, Panitumumab, Adenocarcinoma / genetics, Palliative Care, Antineoplastic Combined Chemotherapy Protocols / therapeutic use*, Neoplasm / genetics, Middle Aged, Proto-Oncogene Proteins B-raf / genetics, Progression-Free Survival, Oxaliplatin, Randomized controlled trial, Disease Progression, Female, Intravenous, Colorectal Neoplasms, Adult, Colorectal Neoplasms / therapy*, Infusions, 610, Adenocarcinoma, Irinotecan, Colorectal Neoplasms / pathology, Adenocarcinoma / mortality, Young Adult, Gastrointestinal cancer, Tumor Burden / drug effects, Adenocarcinoma / therapy*, Humans, Antineoplastic Combined Chemotherapy Protocols / pharmacology, Proto-Oncogene Proteins p21(ras) / genetics*, Aged, Drug Resistance, Neoplasm, Oxaliplatin / pharmacology, Mutation, Panitumumab / therapeutic use*, Biomarkers, Follow-Up Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
19
Top 10%
Average
Top 10%
Green
hybrid
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