Dual Inhibition of EGFR and VEGF in Heavily Pretreated Patients with Metastatic Colorectal Cancer

Oncology. 2017;93(3):191-196. doi: 10.1159/000475818. Epub 2017 May 23.

Abstract

Objective: The aim of this study was to evaluate the efficacy and safety of combining irinotecan, bevacizumab, and cetuximab/panitumumab as a 4th-line treatment in patients with metastatic colorectal cancer.

Methods: All patients had KRAS wild-type metastatic colorectal cancer and had previously received fluoropyrimidine, oxaliplatin, irinotecan, and cetuximab/panitumumab in a 1st, 2nd, and 3rd line setting. Most patients had previously received bevacizumab as well. All patients had progressed within 3 months after the last given treatment before starting the triple combination therapy every second week.

Results: Sixty-three patients were evaluated. The triple combination therapy was well tolerated. The median progression-free survival was 6.1 months, and the median overall survival was 11.9 months. Four patients (6%) obtained a partial response, and 40 (63%) had stable disease.

Conclusion: The combination of irinotecan, bevacizumab, and cetuximab/panitumumab is safe and shows a toxicity profile corresponding to what is expected from the agents alone. The results indicate that the combination in the 4th line may result in a high rate of disease control in heavily pretreated patients with metastatic colorectal cancer.

Keywords: 4th-line therapy; Bevacizumab; Cetuximab; EGFR inhibitor; Irinotecan; Metastatic colorectal cancer; Panitumumab.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols*
  • Bevacizumab
  • Camptothecin / analogs & derivatives
  • Cetuximab
  • Colorectal Neoplasms / drug therapy*
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology
  • Disease-Free Survival
  • Drug Administration Schedule
  • ErbB Receptors / drug effects*
  • Female
  • Fluorouracil
  • Humans
  • Irinotecan
  • Male
  • Middle Aged
  • Organoplatinum Compounds
  • Oxaliplatin
  • Panitumumab
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / drug effects*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Organoplatinum Compounds
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Oxaliplatin
  • Bevacizumab
  • Panitumumab
  • Irinotecan
  • EGFR protein, human
  • ErbB Receptors
  • Cetuximab
  • Fluorouracil
  • Camptothecin