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Clinical Trial
. 2016 Aug 9;115(4):420-4.
doi: 10.1038/bjc.2016.208. Epub 2016 Jul 19.

Patterns of progression, treatment of progressive disease and post-progression survival in the New EPOC study

Siân A Pugh  1 , Megan Bowers  2 , Alexandre Ball  3 , Stephen Falk  4 , Meg Finch-Jones  4   5 , Juan W Valle  6 , Derek A O'Reilly  7   8 , Ajith K Siriwardena  9 , Joanne Hornbuckle  10 , Myrddin Rees  11 , Charlotte Rees  12 , Tim Iveson  13 , Tamas Hickish  14   15 , Tom Maishman  2 , Louise Stanton  2 , Elizabeth Dixon  2 , Andrea Corkhill  2 , Mike Radford  2 , O James Garden  16 , David Cunningham  17 , Tim S Maughan  18 , John A Bridgewater  19 , John N Primrose  1
Affiliations
Clinical Trial

Patterns of progression, treatment of progressive disease and post-progression survival in the New EPOC study

Siân A Pugh et al. Br J Cancer. .

Abstract

Background: The addition of cetuximab (CTX) to perioperative chemotherapy (CT) for operable colorectal liver metastases resulted in a shorter progression-free survival. Details of disease progression are described to further inform the primary study outcome.

Methods: A total of 257 KRAS wild-type patients were randomised to CT alone or CT with CTX. Data regarding sites and treatment of progressive disease were obtained for the 109 (CT n=48, CT and CTX n=61) patients with progressive disease at the cut-off date for analysis of November 2012.

Results: The liver was the most frequent site of progression (CT 67% (32/48); CT and CTX 66% (40/61)). A higher proportion of patients in the CT and group had multiple sites of progressive disease (CT 8%, 4/48; CT and CTX 23%, 14/61 P=0.04). Further treatment for progressive disease is known for 84 patients of whom 69 received further CT, most frequently irinotecan based. Twenty-two patients, 11 in each arm, received CTX as a further line agent.

Conclusions: Both the distribution of progressive disease and further treatment are as expected for such a cohort. The pattern of disease progression seen is consistent with failure of systemic micrometastatic disease control rather than failure of local disease control following liver surgery.

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Conflict of interest statement

SF declared a consulting or advisory role to Merck. JV declared honoraria and travel/accommodation expenses from Merck. DO declared honoraria from Abbott and travel/accommodation expenses from Novartis and Angiodynamics. CR declared travel/accommodation expenses from Roche, Merck and Amgen. TI declared receiving honoraria from Roche and Celgene, a consulting or advisory role to Roche and Servier, and travel/accommodation expenses from Amgen and Bayer. OJG declared honoraria from Johnson and Johnson (Ethicon). DC declared receiving honoraria/research funding from Amgen, AstraZeneca, Bayer, Celgene, Medimmune, Merrimack, Merck Serono, and Sanofi. TM declared honoraria from Vertex, a consulting or advisory Role to Sanofi and research funding from AstraZeneca (Inst) and Merck Serono (Inst). JB declared receiving honoraria from Merck and Roche, attending a speakers' bureau for Merck Serono and receiving travel/accommodation expenses from Merck. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve of post-progression survival by treatment group.
Figure 2
Figure 2
Kaplan–Meier curve of post-progression survival according to whether treatment of progressive disease was undertaken with curative or palliative intent.
See this image and copyright information in PMC

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