Comparison of FOLFIRI With or Without Cetuximab in Patients With Resected Stage III Colon Cancer; NCCTG (Alliance) Intergroup Trial N0147

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Abstract

In the randomized phase III trial N0147 for resected colon cancer, the early trial versions included treatment arms of FOLFIRI (irinotecan, 5-fluorouracil, and leucovorin) with and without cetuximab, in addition to FOLFOX (oxaliplatin, 5-fluorouracil, and leucovorin) with and without cetuximab. In the small group receiving FOLFIRI plus cetuximab evidence of possible benefit was noted. However, pending results of a randomized trial, FOLFIRI plus cetuximab should not be considered as an option for adjuvant therapy.

Background:

Two arms with FOLFIRI, with or without cetuximab, were initially included in the randomized phase III intergroup clinical trial NCCTG (North Central Cancer Treatment Group) N0147. When other contemporary trials demonstrated no benefit to using irinotecan as adjuvant therapy, the FOLFIRI-containing arms were discontinued. We report the clinical outcomes for patients randomized to FOLFIRI with or without cetuximab.

Patients and Methods:

After resection, patients were randomized to 12 biweekly cycles of FOLFIRI, with or without cetuximab. KRAS (Kirsten rat sarcoma viral oncogene homolog) mutation status was retrospectively determined in a central lab. The primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS) and toxicity.

Results:

One hundred and six patients received FOLFIRI and 40 received FOLFIRI plus cetuximab. Median follow-up was 5.95 years (range, 0.1–7.0 years). The addition of cetuximab showed a trend toward improved DFS (hazard ratio [HR], 0.53; 95% CI, 0.26–1.1; P = .09) and OS (HR, 0.45; 95% CI, 0.17–1.16; P = .10) in the overall group, regardless of KRAS status, and in patients with wild type KRAS. Grade ≥ 3 nonhematologic adverse effects were significantly increased in the cetuximab versus FOLFIRI-alone arm (68% vs. 46%; P = .02). Adjuvant FOLFIRI resulted in a 3-year DFS less than that expected for FOLFOX.

Conclusion:

In this small randomized subset of patients with resected stage III colon cancer, the addition of cetuximab to FOLFIRI was associated with a nonsignificant trend toward improved DFS and OS. Nevertheless, considering the limitations of this analysis, FOLFOX without the addition of a biologic agent remains the standard of care for adjuvant therapy in resected stage III colon cancer.

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