TY - JOUR
T1 - Clinicians’ Attitude to Doublet Plus Anti-EGFR Versus Triplet Plus Bevacizumab as First-line Treatment in Left-Sided RAS and BRAF Wild-Type Metastatic Colorectal Cancer Patients
T2 - A Multicenter, “Real-Life”, Case-Control Study
AU - Parisi, Alessandro
AU - Porzio, Giampiero
AU - Cannita, Katia
AU - Venditti, Olga
AU - Avallone, Antonio
AU - Filippi, Roberto
AU - Salvatore, Lisa
AU - Tortora, Giampaolo
AU - Ribelli, Marta
AU - Nigro, Olga
AU - Gelsomino, Fabio
AU - Spallanzani, Andrea
AU - Zurlo, Valeria
AU - Leo, Silvana
AU - Dell'Aquila, Emanuela
AU - Claudia, Fulgenzi
AU - Lombardi, Pasquale
AU - Keränen, Susana Roselló
AU - Aimar, Giacomo
AU - Depetris, Ilaria
AU - Giampieri, Riccardo
AU - Morelli, Cristina
AU - De Tursi, Michele
AU - Tinari, Nicola
AU - Di Pietro, Francesca Romana
AU - De Galitiis, Federica
AU - Zanaletti, Nicoletta
AU - Troiani, Teresa
AU - Vitale, Pasquale
AU - Garajova, Ingrid
AU - Ghidini, Michele
AU - Spinelli, Gian Paolo
AU - Zoratto, Federica
AU - Roberto, Michela
AU - Ierino, Debora
AU - Petrillo, Angelica
AU - D'Orazio, Carla
AU - Ficorella, Corrado
AU - Cortellini, Alessio
N1 - Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors; it is aimed at improving the clinical practice. The study meets all the Italian nonprofit requirements.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021
Y1 - 2021
N2 - Background: Doublets plus antiepidermal growth factor receptors monoclonal antibodies (EGFRi) are widely considered the preferable first-line regimen in patients with left-sided RAS/BRAF wild-type metastatic colorectal cancer (mCRC), resulting superior in terms of activity and efficacy compared to doublets plus bevacizumab. However, data comparing doublet plus EGFRi and triplet plus bevacizumab are lacking, and the relative benefit of an intensive regimen plus an antiangiogenic backbone in this population is debated. Methods: This multicenter, retrospective study aimed at evaluating clinicians’ attitude to triplet-bevacizumab and doublet-EGFRi as first-line regimen in patients with left-sided RAS/BRAF wild-type mCRC treated in clinical practice at 22 Oncology Units from March 2012 to October 2020. A random case-control matching was performed to compare activity (ORR), and effectiveness (PFS, OS, secondary resection rate of metastases with curative intent) between triplet-bevacizumab and doublet-EGFRi, on the basis of ECOG-PS, age, gender, and burden of disease. Results: A total of 718 patients were consecutively treated with doublet-EGFRi (686, 95.5%) or triplet-bevacizumab (32, 4.5%). After case-control matching, median PFS was 13.6 (95% CI, 8.9-31.7) and 16.1 (95% CI, 12.1-36.8) months (P= .621), while median OS was 30.2 (95% CI, 14.4-69.5) and 38.1 (95% CI, 33.1-101.1) months (P= .0283) in the doublet-EGFRi and the triplet-bevacizumab cohort, respectively. The ORR was 65.6% and 90.6% (P= .016), while the secondary resection rate was 18.8% and 46.9% (P= .016), in the doublet-EGFRi and the triplet-bevacizumab cohort, respectively. Triplet-bevacizumab was associated with a higher incidence of G3/G4 neutropenia (25.0% vs. 12.5%, P= .041). Conclusion: Although a doublet-EGFRi remains the recommended upfront regimen in patients with left-sided RAS and BRAF wild-type mCRC, our real life data suggest a triplet-bevacizumab might be at least equally active and effective in properly selected cases.
AB - Background: Doublets plus antiepidermal growth factor receptors monoclonal antibodies (EGFRi) are widely considered the preferable first-line regimen in patients with left-sided RAS/BRAF wild-type metastatic colorectal cancer (mCRC), resulting superior in terms of activity and efficacy compared to doublets plus bevacizumab. However, data comparing doublet plus EGFRi and triplet plus bevacizumab are lacking, and the relative benefit of an intensive regimen plus an antiangiogenic backbone in this population is debated. Methods: This multicenter, retrospective study aimed at evaluating clinicians’ attitude to triplet-bevacizumab and doublet-EGFRi as first-line regimen in patients with left-sided RAS/BRAF wild-type mCRC treated in clinical practice at 22 Oncology Units from March 2012 to October 2020. A random case-control matching was performed to compare activity (ORR), and effectiveness (PFS, OS, secondary resection rate of metastases with curative intent) between triplet-bevacizumab and doublet-EGFRi, on the basis of ECOG-PS, age, gender, and burden of disease. Results: A total of 718 patients were consecutively treated with doublet-EGFRi (686, 95.5%) or triplet-bevacizumab (32, 4.5%). After case-control matching, median PFS was 13.6 (95% CI, 8.9-31.7) and 16.1 (95% CI, 12.1-36.8) months (P= .621), while median OS was 30.2 (95% CI, 14.4-69.5) and 38.1 (95% CI, 33.1-101.1) months (P= .0283) in the doublet-EGFRi and the triplet-bevacizumab cohort, respectively. The ORR was 65.6% and 90.6% (P= .016), while the secondary resection rate was 18.8% and 46.9% (P= .016), in the doublet-EGFRi and the triplet-bevacizumab cohort, respectively. Triplet-bevacizumab was associated with a higher incidence of G3/G4 neutropenia (25.0% vs. 12.5%, P= .041). Conclusion: Although a doublet-EGFRi remains the recommended upfront regimen in patients with left-sided RAS and BRAF wild-type mCRC, our real life data suggest a triplet-bevacizumab might be at least equally active and effective in properly selected cases.
KW - Cetuximab
KW - FOLFIRI
KW - FOLFOX
KW - FOLFOXIRI
KW - mCRC
KW - Panitumumab
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U2 - 10.1016/j.clcc.2021.07.003
DO - 10.1016/j.clcc.2021.07.003
M3 - Article
AN - SCOPUS:85112154399
JO - Clinical Colorectal Cancer
JF - Clinical Colorectal Cancer
SN - 1533-0028
ER -