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Comparison of cetuximab to bevacizumab as the first-line bio-chemotherapy for patients with metastatic colorectal cancer: Superior progression-free survival is restricted to patients with measurable tumors and objective tumor response—a retrospective study

  • Original Article – Clinical Oncology
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Abstract

Purpose

We aimed to compare the treatment efficacy of cetuximab versus bevacizumab in combination with either irinotecan-based or oxaliplatin-based regimens (targeted triplet) as the first-line treatment for patients with metastatic colorectal cancer.

Methods

Between April 2005 and March 2012, patients (n = 158) diagnosed with metastatic colorectal cancer after at least four courses of first-line bevacizumab-based (n = 95) or cetuximab-based triplet (n = 63) were retrospectively analyzed. The KRAS genotypes were sequenced for all patients. The Kaplan–Meier method was used for survival analysis, and Cox proportional hazards models were used for univariate and multivariate analyses.

Results

Cetuximab-based triplet was associated with a higher objective response rate (66.0 vs. 47.2 %, p = 0.037) and a higher conversion rate to resectability (39.7 vs. 20.0 %, p = 0.007) compared to bevacizumab-based triplet. Compared with bevacizumab-based triplet, cetuximab-based triplet significantly increased progression-free survival in patients with measurable metastatic colorectal cancer who achieved objective tumor response (responders) (median 13.1 vs. 10.5 months, p = 0.023), but no significant increase was observed for overall survival. After adjustment for group differences in baseline characteristics and combined chemotherapy agents, cetuximab-based triplet remained an independent determinant of progression-free survival in responders as compared with bevacizumab-based triplet. KRAS mutation was not a prognostic factor in patients with metastatic colorectal cancer.

Conclusions

As compared with bevacizumab-based triplet, cetuximab-based triplet as the first-line treatment of metastatic colorectal cancer was associated with better progression-free survival in patients with measurable tumors who achieved objective tumor response to bio-chemotherapy.

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Acknowledgments

The authors thank the Division of Experimental Surgery of the Department of Surgery, Taipei Veterans General Hospital, and the Taipei Veterans General Hospital, Taiwan Clinical Oncology Research Foundation, Department of Health, Taiwan, for their support for our work.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan

    Yuan-Hao Yang, Chueh-Chuan Yen, Cheng-Hwai Tzeng & Hao-Wei Teng

  2. Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Jen-Kou Lin, Wei-Shone Chen, Tzu-Chen Lin, Shung-Haur Yang, Jeng-Kai Jiang, Yuan-Tzu Lan & Chun-Chi Lin

  3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Yuan-Hao Yang, Chueh-Chuan Yen, Cheng-Hwai Tzeng & Hao-Wei Teng

  4. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Yuan-Hao Yang, Jen-Kou Lin, Wei-Shone Chen, Tzu-Chen Lin, Shung-Haur Yang, Jeng-Kai Jiang, Yuan-Tzu Lan, Chun-Chi Lin, Cheng-Hwai Tzeng & Hao-Wei Teng

  5. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan

    Yuan-Hao Yang

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Correspondence to Hao-Wei Teng.

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432_2014_1741_MOESM1_ESM.tif

aObjective tumor response and b the intensity of objective tumor response (26.4 % strong versus 39.6 % weak) in the cetuximab group. c Objective response and d the intensity of objective tumor response (8.3 % strong versus 38.9 % weak) in the bevacizumab group. CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease (TIFF 16793 kb)

432_2014_1741_MOESM2_ESM.tif

aProgression-free survival (PFS) and b overall survival (OS) of patients with non-measurable tumors, according to targeted agents. c PFS and d OS of patients with stable plus progressive disease according to targeted agents. SD, stable disease; PD, progressive disease (TIFF 16584 kb)

432_2014_1741_MOESM3_ESM.tif

aProgression-free survival of all patients according to metastasectomy status. b Overall survival of all patients according to metastasectomy status. HR, hazard ratio (TIFF 7255 kb)

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Yang, YH., Lin, JK., Chen, WS. et al. Comparison of cetuximab to bevacizumab as the first-line bio-chemotherapy for patients with metastatic colorectal cancer: Superior progression-free survival is restricted to patients with measurable tumors and objective tumor response—a retrospective study. J Cancer Res Clin Oncol 140, 1927–1936 (2014). https://doi.org/10.1007/s00432-014-1741-0

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