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Conference Paper: Cetuximab beyond progression in Kras wild-type metastatic colorectal cancer

TitleCetuximab beyond progression in Kras wild-type metastatic colorectal cancer
Authors
KeywordsMedical sciences
Oncology
Issue Date2013
PublisherOxford University Press. The Journal's web site is located at http://annonc.oxfordjournals.org/
Citation
The ESMO 15th World Congress on Gastrointestinal Cancer, Barcelona, Spain, 3-6 July 2013. In Annals of Oncology, 2013, v. 24 suppl. 4, p. iv108, abstract P-0254 How to Cite?
AbstractBackground: Cetuximab and bevacizumab have proven efficacy in the treatment of metastatic colorectal cancer (mCRC). Although new agents such as panitumumab, aflibercept and regorafenib emerge with modest clinical benefit, they are still not widely available. With limited options of target therapy, treatment with individual agent beyond progression is an attractive strategy and use of bevacizumab in this setting has been shown to improve survival. However, evidence for applying the same strategy to cetuximab is not clear. We performed a retrospective analysis to evaluate the clinical benefit of cetuximab beyond progression in Kras wild-type mCRC. Methods: From January 2008 to December 2010, all patients referred to our department for further management of colorectal cancer were screened. Patients were eligible for further analysis if all the following criteria were met: [1] Kras wild-type mCRC, [2] received more than one line of systemic treatment, [3] no metastasectomy of curative intent performed, and [4] details of pre-referral treatment available. The primary end-point was median overall survival. Survival rate was estimated by the Kaplan-Meier method and predictors of outcomes were analyzed using Cox regression method. Statistical analysis was performed using SPSS. Results: From January 2008 to December 2010, 732 patients were referred to our department for further management of colorectal cancer and 419 of them had either synchronous or metachronous metastatic disease. 55 patients met all the criteria for further analysis. The median age was 57 and 98% of them had good performance status (ECOG 0-1). 86% of patients presented with synchronous metastasis and 63% of patient had metastatic disease involving more than one organ. 31% of patients received more than 2 lines of systemic therapy (median: 2 cycles, range: 2-5 cycles). 75% of patients have been treated with all standard chemotherapeutic agents (oxaliplatin, irinotecan and fluoropyrimidine) while 42% of patients had exposure to both cetuximab and bevacizumab. The median follow-up was 20.1 months and 47 patients have died. The median overall survival was 21.2 months (95% CI: 20.4 – 27.1months). Using the Cox regression method, neither exposure to all standard chemotherapeutic agents nor exposure to all standard target therapies (cetuximab or bevacizumab) were significant predictors of outcomes on univariate analysis. Upon multivariate analysis, baseline platelet count >400 x 109/L (HR 2.35, 95% CI: 1.01-5.45, p = 0.047), metastasis involving more than one organ (HR 1.92, 95% CI: 1.01-3.66, p = 0.046) and cetuximab-based therapy given in at least 2 lines of treatment (HR 0.47, 95% CI: 0.24-0.90, p = 0.022) were significant predictors of survival. Conclusion: In patients with Kras wild-type mCRC who are not candidate for metastasectomy of curative intent, the use of cetuximab beyond progression is associated with 53% lower risk of death (p = 0.022). Baseline patient characteristics including increased platelet count (p = 0.047) and metastasis involving more than one organ (p = 0.046) remain significant as predictors of inferior survival in this group of patients.
DescriptionPosters: P-0254
Persistent Identifierhttp://hdl.handle.net/10722/186710
ISSN
2020 Impact Factor: 32.976
2015 SCImago Journal Rankings: 4.362

 

DC FieldValueLanguage
dc.contributor.authorLam, KOen_US
dc.contributor.authorLee, Ven_US
dc.contributor.authorChoi, CWen_US
dc.contributor.authorSze, HCKen_US
dc.contributor.authorKwok, RCCen_US
dc.contributor.authorShum, BCYen_US
dc.contributor.authorWong, IWCen_US
dc.contributor.authorTsang, JWHen_US
dc.contributor.authorLiu, RKYen_US
dc.contributor.authorLeung, TWen_US
dc.contributor.authorKwong, DLWen_US
dc.date.accessioned2013-08-20T12:18:05Z-
dc.date.available2013-08-20T12:18:05Z-
dc.date.issued2013en_US
dc.identifier.citationThe ESMO 15th World Congress on Gastrointestinal Cancer, Barcelona, Spain, 3-6 July 2013. In Annals of Oncology, 2013, v. 24 suppl. 4, p. iv108, abstract P-0254en_US
dc.identifier.issn0923-7534-
dc.identifier.urihttp://hdl.handle.net/10722/186710-
dc.descriptionPosters: P-0254-
dc.description.abstractBackground: Cetuximab and bevacizumab have proven efficacy in the treatment of metastatic colorectal cancer (mCRC). Although new agents such as panitumumab, aflibercept and regorafenib emerge with modest clinical benefit, they are still not widely available. With limited options of target therapy, treatment with individual agent beyond progression is an attractive strategy and use of bevacizumab in this setting has been shown to improve survival. However, evidence for applying the same strategy to cetuximab is not clear. We performed a retrospective analysis to evaluate the clinical benefit of cetuximab beyond progression in Kras wild-type mCRC. Methods: From January 2008 to December 2010, all patients referred to our department for further management of colorectal cancer were screened. Patients were eligible for further analysis if all the following criteria were met: [1] Kras wild-type mCRC, [2] received more than one line of systemic treatment, [3] no metastasectomy of curative intent performed, and [4] details of pre-referral treatment available. The primary end-point was median overall survival. Survival rate was estimated by the Kaplan-Meier method and predictors of outcomes were analyzed using Cox regression method. Statistical analysis was performed using SPSS. Results: From January 2008 to December 2010, 732 patients were referred to our department for further management of colorectal cancer and 419 of them had either synchronous or metachronous metastatic disease. 55 patients met all the criteria for further analysis. The median age was 57 and 98% of them had good performance status (ECOG 0-1). 86% of patients presented with synchronous metastasis and 63% of patient had metastatic disease involving more than one organ. 31% of patients received more than 2 lines of systemic therapy (median: 2 cycles, range: 2-5 cycles). 75% of patients have been treated with all standard chemotherapeutic agents (oxaliplatin, irinotecan and fluoropyrimidine) while 42% of patients had exposure to both cetuximab and bevacizumab. The median follow-up was 20.1 months and 47 patients have died. The median overall survival was 21.2 months (95% CI: 20.4 – 27.1months). Using the Cox regression method, neither exposure to all standard chemotherapeutic agents nor exposure to all standard target therapies (cetuximab or bevacizumab) were significant predictors of outcomes on univariate analysis. Upon multivariate analysis, baseline platelet count >400 x 109/L (HR 2.35, 95% CI: 1.01-5.45, p = 0.047), metastasis involving more than one organ (HR 1.92, 95% CI: 1.01-3.66, p = 0.046) and cetuximab-based therapy given in at least 2 lines of treatment (HR 0.47, 95% CI: 0.24-0.90, p = 0.022) were significant predictors of survival. Conclusion: In patients with Kras wild-type mCRC who are not candidate for metastasectomy of curative intent, the use of cetuximab beyond progression is associated with 53% lower risk of death (p = 0.022). Baseline patient characteristics including increased platelet count (p = 0.047) and metastasis involving more than one organ (p = 0.046) remain significant as predictors of inferior survival in this group of patients.-
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://annonc.oxfordjournals.org/en_US
dc.relation.ispartofAnnals of Oncologyen_US
dc.subjectMedical sciences-
dc.subjectOncology-
dc.titleCetuximab beyond progression in Kras wild-type metastatic colorectal canceren_US
dc.typeConference_Paperen_US
dc.identifier.emailLam, KO: lamkaon@hku.hken_US
dc.identifier.emailLee, V: vhflee@hku.hken_US
dc.identifier.emailChoi, CW: hcchoi@hku.hken_US
dc.identifier.emailSze, HCK: henrysze@graduate.hku.hken_US
dc.identifier.emailTsang, JWH: jwhtsang@hku.hken_US
dc.identifier.emailLiu, RKY: ricoliu@hkucc.hku.hken_US
dc.identifier.emailLeung, TW: ltw920@hkucc.hku.hken_US
dc.identifier.emailKwong, DLW: dlwkwong@hku.hken_US
dc.identifier.authorityLam, KO=rp01501en_US
dc.identifier.authorityLee, V=rp00264en_US
dc.identifier.authoritySze, HCK=rp01697en_US
dc.identifier.authorityTsang, JWH=rp00278en_US
dc.identifier.authorityKwong, DLW=rp00414en_US
dc.description.natureabstract-
dc.identifier.doi10.1093/annonc/mdt203.252-
dc.identifier.hkuros218675en_US
dc.identifier.volume24en_US
dc.identifier.issuesuppl. 4-
dc.identifier.spageiv108, abstract P-0254-
dc.identifier.epageiv108, abstract P-0254-
dc.publisher.placeUnited Kingdom-
dc.customcontrol.immutablesml 140409-
dc.identifier.issnl0923-7534-

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