Differential Efficacy of Targeted Monoclonal Antibodies in Left-Sided Colon and Rectal Metastatic Cancers

The recommended first-line chemotherapy for RAS/BRAF wild-type metastatic colorectal cancer (mCRC) is bevacizumab (BEV)-containing therapy for right-sided colon cancer (R) and antiepidermal growth factor receptor antibody (anti-EGFR)-containing therapy for left-sided colon cancer (L) or rectal cance...

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Veröffentlicht in:Clinical colorectal cancer 2023-09, Vol.22 (3), p.298-306
Hauptverfasser: Kodama, Hiroyuki, Masuishi, Toshiki, Wakabayashi, Munehiro, Nakata, Akinobu, Kumanishi, Ryosuke, Nakazawa, Taiko, Ogata, Takatsugu, Matsubara, Yuki, Honda, Kazunori, Narita, Yukiya, Taniguchi, Hiroya, Kadowaki, Shigenori, Ando, Masashi, Muro, Kei
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Sprache:eng
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Zusammenfassung:The recommended first-line chemotherapy for RAS/BRAF wild-type metastatic colorectal cancer (mCRC) is bevacizumab (BEV)-containing therapy for right-sided colon cancer (R) and antiepidermal growth factor receptor antibody (anti-EGFR)-containing therapy for left-sided colon cancer (L) or rectal cancer (RE). However, anatomical or biological heterogeneity reportedly exists between L and RE. Therefore, we aimed to compare the efficacies of anti-EGFR and BEV therapies for L and RE, respectively. We retrospectively reviewed 265 patients with KRAS (RAS)/BRAF wild-type mCRC treated with fluoropyrimidine-based doublet chemotherapy plus anti-EGFR or BEV as the first-line treatment at a single institution. They were divided into 3 groups: R, L, and RE. Overall survival (OS), progression-free survival (PFS), objective response rate, and conversion surgery rate were analyzed. Forty-five patients had R (anti-EGFR/BEV: 6/39), 137 patients had L (45/92), and 83 patients had RE (25/58). In patients with R, both median (m) PFS and OS were superior with BEV therapy (mPFS, anti-EGFR vs. BEV: 8.7 vs. 13.0 months, hazard ratio [HR]: 3.90, P = .01; mOS, 17.1 vs. 33.9 months, HR: 1.54, P = .38). In patients with L, better mPFS and comparable mOS with anti-EGFR therapy were observed (mPFS, 20.0 vs. 13.4 months, HR: 0.68, P = .08; mOS, 44.8 vs. 36.0 months, HR: 0.87, P = .53), whereas, in patients with RE, comparable mPFS and worse mOS with anti-EGFR therapy were observed (mPFS, 17.2 vs. 17.8 months, HR: 1.08, P = .81; mOS, 29.1 vs. 42.2 months, HR: 1.53, P = .17). Efficacies of anti-EGFR and BEV therapies may differ between patients with L and RE. Anatomical or biological heterogeneity reportedly exists between left-sided colon (L) and rectal cancers (RE). We reviewed 265 patients with RAS/BRAF wild-type metastatic colorectal cancer (mCRC) and compared the efficacy of anti-EGFR antibody and bevacizumab therapies for L and RE. Our study demonstrated the differential efficacy with anti-EGFR antibody and bevacizumab therapies between L and RE.
ISSN:1533-0028
1938-0674
DOI:10.1016/j.clcc.2023.05.002