Sequential therapy with bevacizumab and EGFR inhibitors for metastatic colorectal carcinoma: a national registry-based analysis

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Authors	BUCHLER Tomas CHLOUPKOVÁ Renata POPRACH Alexandr FIALA Ondrej KISS Igor KOPECKOVA Katerina DUŠEK Ladislav VESKRNOVA Veronika SLAVICEK Lubomir KOHOUTEK Milan FINEK Jindrich SVOBODA Marek PETRUZELKA Lubos MELICHAR Bohuslav
Year of publication	2019
Type	Article in Periodical
Magazine / Source	CANCER MANAGEMENT AND RESEARCH
MU Faculty or unit	Faculty of Medicine
Citation
Web	http://dx.doi.org/10.2147/CMAR.S183093
Doi	http://dx.doi.org/10.2147/CMAR.S183093
Keywords	colorectal carcinoma; bevacizumab; panitumumab; cetuximab; sequence
Description	Purpose: Although inhibitors of vascular endothelial growth factor and inhibitors of epidermal growth factor receptor (EGFRi) are commonly used for the treatment of metastatic colorectal cancer (mCRC), the optimal sequencing of the agents is currently unclear. Methods: A national registry of targeted therapies was used to analyze baseline characteristics and outcomes of patients with mCRC and wild-type KRAS exon 2 status who received bevacizumab and EGFRi (cetuximab or panitumumab) as a part of first- and second-line treatment in either sequence. Results: The cohort included 490 patients (181 patients treated with first-line EGFRi and second-line bevacizumab and 309 patients treated with first-line bevacizumab and second-line EGFRi). Median overall survival (OS) from the initiation on first-line therapy was similar for patients treated with either sequence, reaching 31.8 (95% CI 27.5-36.1) vs 31.4 months (95% CI 27.8-35.0) for EGFRi -> bevacizumab vs bevacizumab -> EGFRi cohort, respectively. Time from first-line initiation to progression on the second-line therapy [progression-free survival (PFS)] was 21.1 (95% CI 19.3-23.0) vs 19.3 months (95% CI 17.3-21.3) for bevacizumab -> EGFRi vs EGFRi -> bevacizumab cohort, respectively (P=0.016). Conclusion: This retrospective analysis of real-world data of patients with wild-type KRAS exon 2 mCRC showed no differences in OS between cohorts treated with bevacizumab -> EGFRi vs the reverse sequence while combined PFS favored the bevacizumab -> EGFRi sequence.