Anti–Epidermal Growth Factor Receptor Maintenance Therapy in Metastatic Colorectal Cancer—Another Piece to the Puzzle
Mené sur 214 patients atteints d'un cancer colorectal de stade métastatique et sans mutation au niveau du gène RAS (âge médian : 67 ans ; durée médiane de suivi : 40,5 mois), cet essai de phase II évalue l'efficacité, du point de vue de la survie sans progression à 6 mois, et la toxicité du cétuximab en traitement d'entretien après un traitement d'induction combinant cétuximab et chimiothérapie de type FOLFIRI
According to current guidelines, doublet chemotherapy plus an anti–epidermal growth factor receptor (EGFR) agent is the recommended upfront treatment option in patients with RAS or BRAF wild-type metastatic colorectal cancer (mCRC), specifically in left-sided tumors. Although these combinations have significantly improved overall survival (OS), up to approximately 3 years, the duration of first-line therapy is still a matter of debate. Disabling and cumulative adverse effects, especially oxaliplatin-related neuropathy, can worsen during prolonged treatment, severely affecting quality of life. The need to limit these toxic effects in patients with disease not amenable to local treatment after achieving maximum tumor response has led to the idea of intermittent or maintenance therapy. Several randomized clinical trials have investigated different therapeutic approaches, such as observation or deescalation of treatment intensity, instead of continuing induction therapy until disease progression. Data are more robust with bevacizumab used as the targeted agent in maintenance setting. A 2020 network meta-analysis found no benefit from continuing bevacizumab-based induction therapy until progressive disease (PD), while a significant progression-free survival (PFS) benefit was documented with fluoropyrimidine (5-FU) and leucovorin (LV) plus bevacizumab as maintenance therapy vs observation. However, no significant trend for overall survival (OS) was observed in favor of maintenance therapy.
JAMA Network Open 2023