A randomized Phase II clinical study of combining panitumumab and bevacizumab, plus irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) compared with FOLFIRI alone as second-line treatment for patients with metastatic colorectal cancer and KRAS mutation

Abstract

Background: This study investigated the efficacy and safety of a new treatment strategy of combining panitumumab and bevacizumab, plus irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) versus FOLFIRI alone as second-line chemotherapy for metastatic colorectal cancer (mCRC) patients with known V-Ki-ras2 Kirsten rat sarcoma viral oncogene (KRAS) mutation status.

Methods: Patients with mCRC who had known KRAS tumor status and unsuccessful previous oxaliplatin-based chemotherapy were included in the study. They were randomly assigned to two groups to receive panitumumab and bevacizumab plus FOLFIRI, or FOLFIRI alone. In panitumumab and bevacizumab plus FOLFIRI group, patients were given 4 mg/kg panitumumab and bevacizumab plus FOLFIRI every 2 weeks.

Results: In all, 65 patients were assigned to panitumumab and bevacizumab plus FOLFIRI group, and 77 to FOLFIRI alone group. For WT KRAS patients, the median progression-free survival (PFS) was 5.7 months (95% confidence interval [CI], 2.4-7.5 months) for panitumumab and bevacizumab plus FOLFIRI and 3.8 months (95% CI, 3.0-6.7 months) for FOLFIRI alone; median overall survival (OS) was 15.2 months (95% CI, 8.9-19.7 months) for panitumumab and bevacizumab plus FOLFIRI and 11.0 months (95% CI, 8.2-15.4 months) for FOLFIRI alone. For MU KRAS patients, median PFS was 5.1 months (95% CI, 2.7-10.2 months) for panitumumab and bevacizumab plus FOLFIRI and 4.1 months (95% CI, 2.5-8.4 months) for FOLFIRI alone; median OS was 12.8 months (95% CI, 7.8-15.8 months) for panitumumab and bevacizumab plus FOLFIRI and 10.5 months (95% CI, 6.1-15.3 months) for FOLFIRI alone. Grade 3 and 4 adverse events were associated with panitumumab and bevacizumab plus FOLFIRI but tolerable among patients.

Conclusion: Patients with mCRC can be safely and efficiently treated with second-line chemotherapy of combining panitumumab and bevacizumab plus FOLFIRI, despite their KRAS mutation status.

Keywords: FOLFIRI; bevacizumab; metastatic colorectal cancer; panitumumab; second-line chemotherapy.

Figure 1

CONSORT diagram for flow of patients through the study. Abbreviations: FOLFIRI, fluorouracil, leucovorin, and irinotecan; KRAS, V-Ki-ras2 Kirsten rat sarcoma viral oncogene; WT, wild-type; MU, mutant.

Figure 2

Progression-free survival (A) or overall survival (B) for wild-type (WT) KRAS, and progression-free survival (C) or overall survival (D) for mutant (MU) KRAS were examined. Abbreviations: KRAS, V-Ki-ras2 Kirsten rat sarcoma viral oncogene; FOLFIRI, fluorouracil, leucovorin, and irinotecan.