Alexander Kiani, Heinz-Gert Höffkes, Frank Kullmann, Reinhard Udo Lindig, Sebastian Müller, Ingrid Ricard, Dominik Paul Modest, Christian Lerchenmüller, Salah-Eddin Al-Batran, Hartmut Link, Thomas Kirchner, Lisa Miller-Phillips, Andreas Rost, Tobias Heintges, Christoph Kahl, Michael Scholz, Thomas Decker, Ludwig Fischer von Weikersthal, Sebastian Stintzing, Markus Moehler, Ursula Vehling-Kaiser, Andreas Jung, Julian Walter Holch, Jobst Christian von Einem, Volker Heinemann, Werner Scheithauer
In metastatic colorectal cancer (mCRC), liver-limited disease (LLD) is associated with a higher chance of metastectomy leading to long-term survival. However, limited data describes the prognostic and predictive relevance of initially unresectable LLD with regard to targeted first-line therapy.
The present analysis investigated the relevance of initially unresectable LLD in mCRC patients treated with targeted therapy against either the epidermal growth factor receptor (EGFR) or vascular epithelial growth factor (VEGF).
The analysis was performed based on FIRE-3, a randomized phase III trial comparing first-line chemotherapy with FOLFIRI plus either cetuximab (anti-EGFR) or bevacizumab (anti-VEGF) in RAS wild-type (WT) mCRC. Of 400 patients, 133 (33.3%) had LLD and 267 (66.8%) had non-LLD. Median overall survival (OS) was significantly longer in LLD compared to non-LLD patients (36.0 vs. 25.4 months; hazard ratio [HR]=0.66; 95% confidence interval [CI]: 0.51-0.87; P=0.002). In a multivariate analysis also including secondary hepatic resection as time-dependent variable, LLD status was independently prognostic for OS (HR=0.67; 95% CI: 0.50-0.91; P=0.01). As assessed by interaction tests, treatment benefit from FOLFIRI plus cetuximab compared to FOLFIRI plus bevacizumab was independent of LLD status with regard to objective response rate (ORR), early tumour shrinkage ≥20% (ETS), depth of response (DpR) and OS (all P>0.05).
In conclusion, LLD could be identified as a prognostic factor in RAS-WT mCRC, which was independent of hepatic resection in patients treated with targeted therapy. LLD had no predictive relevance since benefit from FOLFIRI plus cetuximab over bevacizumab was independent of LLD status. This article is protected by copyright. All rights reserved.