Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CA-wild-type Metastatic Colorectal Cancer

The AGITG Randomized Phase II ICECREAM Study

Jeremy D. Shapiro, Subotheni Thavaneswaran, Craig R. Underhill, Kristy P. Robledo, Christos S. Karapetis, Fiona L. Day, Louise M. Nott, Michael Jefford, Lorraine A. Chantrill, Nick Pavlakis, Niall C. Tebbutt, Timothy J. Price, Mustafa Khasraw, Guy A. Van Hazel, Paul M. Waring, Sabine Tejpar, John Simes, Val J. Gebski, Jayesh Desai, Eva Segelov

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Most unresectable metastatic colon cancer remains incurable, with a median survival of less than 3 years. Molecularly targeted therapies have recently been developed; in particular, monoclonal antibodies against the epidermal growth factor receptor, which are efficacious in 40% to 60% of chemotherapy-resistant patients with wild-type KRAS. This study shows that cetuximab plus irinotecan, compared with cetuximab alone, increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. Background: The Irinotecan Cetuximab Evaluation and Cetuximab Response Evaluation (ICECREAM) study assessed the efficacy of cetuximab monotherapy compared with cetuximab combined with chemotherapy for quadruple wild-type (KRAS, NRAS, BRAF, or P13KCA exon 20) metastatic colorectal cancer. Patients and Methods: Patients were enrolled in an open-label, multicenter, phase II trial and randomly assigned to cetuximab 400 mg/m2, then 250 mg/m2 cetuximab weekly, with or without irinotecan 180 mg/m2 every 2 weeks. The primary endpoint was 6-month progression-free survival; secondary endpoints were response rate, overall survival, toxicity, and quality of life. Results: From 2012 to 2016, 48 patients were recruited. Two were ineligible, and 2 were not evaluable for response. Characteristics were balanced, except gender (male, 62% vs. 72%) and primary sidedness (left, 95% vs. 68%). For cetuximab compared with cetuximab-irinotecan, progression-free survival was 14% versus 41% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P =.008); response rate was 10% (2 partial responses) versus 38% (1 complete, 8 partial); P =.04. Grade 3 to 4 toxicities were less with cetuximab monotherapy (23% vs. 50%); global and specific quality of life scores did not differ. Conclusion: In comparison with cetuximab alone, cetuximab plus irinotecan increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. This echoes data from molecularly unselected patients.

Original languageEnglish
Pages (from-to)313-319
Number of pages7
JournalClinical Colorectal Cancer
Volume17
Issue number4
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • Cetuximab
  • Chemotherapy colon cancer
  • Irinotecan
  • RAS

Cite this

Shapiro, Jeremy D. ; Thavaneswaran, Subotheni ; Underhill, Craig R. ; Robledo, Kristy P. ; Karapetis, Christos S. ; Day, Fiona L. ; Nott, Louise M. ; Jefford, Michael ; Chantrill, Lorraine A. ; Pavlakis, Nick ; Tebbutt, Niall C. ; Price, Timothy J. ; Khasraw, Mustafa ; Van Hazel, Guy A. ; Waring, Paul M. ; Tejpar, Sabine ; Simes, John ; Gebski, Val J. ; Desai, Jayesh ; Segelov, Eva. / Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CA-wild-type Metastatic Colorectal Cancer : The AGITG Randomized Phase II ICECREAM Study. In: Clinical Colorectal Cancer. 2018 ; Vol. 17, No. 4. pp. 313-319.
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title = "Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CA-wild-type Metastatic Colorectal Cancer: The AGITG Randomized Phase II ICECREAM Study",
abstract = "Most unresectable metastatic colon cancer remains incurable, with a median survival of less than 3 years. Molecularly targeted therapies have recently been developed; in particular, monoclonal antibodies against the epidermal growth factor receptor, which are efficacious in 40{\%} to 60{\%} of chemotherapy-resistant patients with wild-type KRAS. This study shows that cetuximab plus irinotecan, compared with cetuximab alone, increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. Background: The Irinotecan Cetuximab Evaluation and Cetuximab Response Evaluation (ICECREAM) study assessed the efficacy of cetuximab monotherapy compared with cetuximab combined with chemotherapy for quadruple wild-type (KRAS, NRAS, BRAF, or P13KCA exon 20) metastatic colorectal cancer. Patients and Methods: Patients were enrolled in an open-label, multicenter, phase II trial and randomly assigned to cetuximab 400 mg/m2, then 250 mg/m2 cetuximab weekly, with or without irinotecan 180 mg/m2 every 2 weeks. The primary endpoint was 6-month progression-free survival; secondary endpoints were response rate, overall survival, toxicity, and quality of life. Results: From 2012 to 2016, 48 patients were recruited. Two were ineligible, and 2 were not evaluable for response. Characteristics were balanced, except gender (male, 62{\%} vs. 72{\%}) and primary sidedness (left, 95{\%} vs. 68{\%}). For cetuximab compared with cetuximab-irinotecan, progression-free survival was 14{\%} versus 41{\%} (hazard ratio, 0.39; 95{\%} confidence interval, 0.20-0.78; P =.008); response rate was 10{\%} (2 partial responses) versus 38{\%} (1 complete, 8 partial); P =.04. Grade 3 to 4 toxicities were less with cetuximab monotherapy (23{\%} vs. 50{\%}); global and specific quality of life scores did not differ. Conclusion: In comparison with cetuximab alone, cetuximab plus irinotecan increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. This echoes data from molecularly unselected patients.",
keywords = "Cetuximab, Chemotherapy colon cancer, Irinotecan, RAS",
author = "Shapiro, {Jeremy D.} and Subotheni Thavaneswaran and Underhill, {Craig R.} and Robledo, {Kristy P.} and Karapetis, {Christos S.} and Day, {Fiona L.} and Nott, {Louise M.} and Michael Jefford and Chantrill, {Lorraine A.} and Nick Pavlakis and Tebbutt, {Niall C.} and Price, {Timothy J.} and Mustafa Khasraw and {Van Hazel}, {Guy A.} and Waring, {Paul M.} and Sabine Tejpar and John Simes and Gebski, {Val J.} and Jayesh Desai and Eva Segelov",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.clcc.2018.06.002",
language = "English",
volume = "17",
pages = "313--319",
journal = "Clinical Colorectal Cancer",
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}

Shapiro, JD, Thavaneswaran, S, Underhill, CR, Robledo, KP, Karapetis, CS, Day, FL, Nott, LM, Jefford, M, Chantrill, LA, Pavlakis, N, Tebbutt, NC, Price, TJ, Khasraw, M, Van Hazel, GA, Waring, PM, Tejpar, S, Simes, J, Gebski, VJ, Desai, J & Segelov, E 2018, 'Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CA-wild-type Metastatic Colorectal Cancer: The AGITG Randomized Phase II ICECREAM Study', Clinical Colorectal Cancer, vol. 17, no. 4, pp. 313-319. https://doi.org/10.1016/j.clcc.2018.06.002

Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CA-wild-type Metastatic Colorectal Cancer : The AGITG Randomized Phase II ICECREAM Study. / Shapiro, Jeremy D.; Thavaneswaran, Subotheni; Underhill, Craig R.; Robledo, Kristy P.; Karapetis, Christos S.; Day, Fiona L.; Nott, Louise M.; Jefford, Michael; Chantrill, Lorraine A.; Pavlakis, Nick; Tebbutt, Niall C.; Price, Timothy J.; Khasraw, Mustafa; Van Hazel, Guy A.; Waring, Paul M.; Tejpar, Sabine; Simes, John; Gebski, Val J.; Desai, Jayesh; Segelov, Eva.

In: Clinical Colorectal Cancer, Vol. 17, No. 4, 01.12.2018, p. 313-319.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CA-wild-type Metastatic Colorectal Cancer

T2 - The AGITG Randomized Phase II ICECREAM Study

AU - Shapiro, Jeremy D.

AU - Thavaneswaran, Subotheni

AU - Underhill, Craig R.

AU - Robledo, Kristy P.

AU - Karapetis, Christos S.

AU - Day, Fiona L.

AU - Nott, Louise M.

AU - Jefford, Michael

AU - Chantrill, Lorraine A.

AU - Pavlakis, Nick

AU - Tebbutt, Niall C.

AU - Price, Timothy J.

AU - Khasraw, Mustafa

AU - Van Hazel, Guy A.

AU - Waring, Paul M.

AU - Tejpar, Sabine

AU - Simes, John

AU - Gebski, Val J.

AU - Desai, Jayesh

AU - Segelov, Eva

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Most unresectable metastatic colon cancer remains incurable, with a median survival of less than 3 years. Molecularly targeted therapies have recently been developed; in particular, monoclonal antibodies against the epidermal growth factor receptor, which are efficacious in 40% to 60% of chemotherapy-resistant patients with wild-type KRAS. This study shows that cetuximab plus irinotecan, compared with cetuximab alone, increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. Background: The Irinotecan Cetuximab Evaluation and Cetuximab Response Evaluation (ICECREAM) study assessed the efficacy of cetuximab monotherapy compared with cetuximab combined with chemotherapy for quadruple wild-type (KRAS, NRAS, BRAF, or P13KCA exon 20) metastatic colorectal cancer. Patients and Methods: Patients were enrolled in an open-label, multicenter, phase II trial and randomly assigned to cetuximab 400 mg/m2, then 250 mg/m2 cetuximab weekly, with or without irinotecan 180 mg/m2 every 2 weeks. The primary endpoint was 6-month progression-free survival; secondary endpoints were response rate, overall survival, toxicity, and quality of life. Results: From 2012 to 2016, 48 patients were recruited. Two were ineligible, and 2 were not evaluable for response. Characteristics were balanced, except gender (male, 62% vs. 72%) and primary sidedness (left, 95% vs. 68%). For cetuximab compared with cetuximab-irinotecan, progression-free survival was 14% versus 41% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P =.008); response rate was 10% (2 partial responses) versus 38% (1 complete, 8 partial); P =.04. Grade 3 to 4 toxicities were less with cetuximab monotherapy (23% vs. 50%); global and specific quality of life scores did not differ. Conclusion: In comparison with cetuximab alone, cetuximab plus irinotecan increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. This echoes data from molecularly unselected patients.

AB - Most unresectable metastatic colon cancer remains incurable, with a median survival of less than 3 years. Molecularly targeted therapies have recently been developed; in particular, monoclonal antibodies against the epidermal growth factor receptor, which are efficacious in 40% to 60% of chemotherapy-resistant patients with wild-type KRAS. This study shows that cetuximab plus irinotecan, compared with cetuximab alone, increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. Background: The Irinotecan Cetuximab Evaluation and Cetuximab Response Evaluation (ICECREAM) study assessed the efficacy of cetuximab monotherapy compared with cetuximab combined with chemotherapy for quadruple wild-type (KRAS, NRAS, BRAF, or P13KCA exon 20) metastatic colorectal cancer. Patients and Methods: Patients were enrolled in an open-label, multicenter, phase II trial and randomly assigned to cetuximab 400 mg/m2, then 250 mg/m2 cetuximab weekly, with or without irinotecan 180 mg/m2 every 2 weeks. The primary endpoint was 6-month progression-free survival; secondary endpoints were response rate, overall survival, toxicity, and quality of life. Results: From 2012 to 2016, 48 patients were recruited. Two were ineligible, and 2 were not evaluable for response. Characteristics were balanced, except gender (male, 62% vs. 72%) and primary sidedness (left, 95% vs. 68%). For cetuximab compared with cetuximab-irinotecan, progression-free survival was 14% versus 41% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P =.008); response rate was 10% (2 partial responses) versus 38% (1 complete, 8 partial); P =.04. Grade 3 to 4 toxicities were less with cetuximab monotherapy (23% vs. 50%); global and specific quality of life scores did not differ. Conclusion: In comparison with cetuximab alone, cetuximab plus irinotecan increases the response rate and delays progression in irinotecan-resistant RAS wild-type colorectal cancer. This echoes data from molecularly unselected patients.

KW - Cetuximab

KW - Chemotherapy colon cancer

KW - Irinotecan

KW - RAS

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U2 - 10.1016/j.clcc.2018.06.002

DO - 10.1016/j.clcc.2018.06.002

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EP - 319

JO - Clinical Colorectal Cancer

JF - Clinical Colorectal Cancer

SN - 1533-0028

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