Cetuximab plus irinotecan after irinotecan failure in elderly metastatic colorectal cancer patients: Clinical outcome according to KRAS and BRAF mutational status

详细信息    查看全文

• 作者：Lorenzo Fornaro^a ; Giacomo Giulio Baldi^a ; Gianluca Masi^a ; ^{gl.masi@tin.it"" rel=""nofollow} ; Giacomo Allegrini^b ; Fotios Loupakis^a ; Enrico Vasile^a ; Samanta Cupini^c ; Irene Stasi^a ; Lisa Salvatore^a ; Chiara Cremolini^a ; Bruno Vincenzi^d ; Daniele Santini^d ; Giuseppe Tonini^d ; Francesco Graziano^e ; Annamaria Ruzzo^f ; Emanuele Canestrari^f ; Mauro Magnani^f ; Alfredo Falcone^a [Author vitae]
• 关键词：BRAF ; Cetuximab ; Chemotherapy ; Elderly ; KRAS ; Metastatic colorectal cancer
• 刊名：Critical Reviews in Oncology/Hematology
• 出版年：2011
• 出版时间：June 2011
• 年：2011
• 卷：78
• 期：3
• 页码：243-251
• 全文大小：281 K

文摘

Background

Scarce data are available about safety and efficacy of cetuximab in elderly metastatic colorectal cancer (mCRC) patients.

Patients and methods

We retrospectively analysed 54 irinotecan-refractory mCRC patients aged ≥ 70 years treated with cetuximab plus irinotecan and evaluated clinical outcome according to KRAS and BRAF mutational status.

Results

Median age was 73 years (70–82). Main grade 3–4 toxicities were skin rash (15 % ), diarrhea (19 % ) and neutropenia (13 % ). Irinotecan dose reduction was necessary in 39 % of patients. Fifty-two (96 % ) patients were analysed for KRAS and BRAF status. The 29 KRAS wild-type patients achieved better RR (31 % vs 4 % ; p = 0.030) and median PFS (4.21 months vs 3.95 months; p = 0.034; HR: 0.50, 95 % CI: 0.27–0.95) when compared with KRAS mutated ones. RR (41 % vs 3 % ; p = 0.001) and mPFS (4.57 months vs 3.78 months, p = 0.001; HR: 0.35, 95 % CI: 0.19–0.66) were significantly higher among the 22 KRAS and BRAF wild-type patients compared to the 30 KRAS or BRAF mutated ones.

Conclusion

Cetuximab plus irinotecan has a favourable safety profile in elderly mCRC patients, but a reduced dose of irinotecan should be considered. Such a combination can be a useful option for elderly KRAS and BRAF wild-type patients.