Among patients with liver metastases from colorectal cancer, the combination of Erbitux® (cetuximab) and chemotherapy may improve treatment response rates and increase the number of patients who become candidates for surgery. These results were published in Lancet Oncology.
Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. Metastatic colorectal cancer refers to colorectal cancer that has spread to other parts of the body. The liver is a common site of colorectal cancer metastasis.
Surgical removal of liver metastases can improve patient outcomes. Many patients with liver metastases, however, are not candidates for surgery as a result of the extent or location of the cancer. Initial treatment with chemotherapy may reduce the extent of the liver metastases and allow more patients to be treated surgically.
Erbitux is a targeted therapy that inhibits growth of the cancer by binding to a portion of the epidermal growth factor receptor (EGFR), a protein located on the surface of many cancer cells. Erbitux is currently approved for the treatment of selected patients with advanced head and neck cancer or advanced colorectal cancer. Response to Erbitux among patients with colorectal cancer appears to vary by whether or not the tumor contains a mutation in a gene known as KRAS. Tumors with KRAS mutations may not respond to treatment with Erbitux.
The combination of chemotherapy and Erbitux was evaluated among 114 patients with liver metastases from colorectal cancer. At the start of the study, the patients were believed to have liver tumors that could not be surgically removed.
Study participants were assigned to receive Erbitux in combination with one of two chemotherapy regimens (FOLFOX6 or FOLFIRI).
- A response to treatment (a reduction in detectable cancer) was observed in 68% of patients treated with Erbitux and FOLFOX6 and 57% of patients treated with Erbitux and FOLFIRI.
- Response rates were higher among patients whose tumors did not contain a KRAS mutation (70% among patients without a KRAS mutation, compared with 41% among patients with a KRAS mutation).
- Complete surgical removal of all tumors was possible in 38% of patients treated with Erbitux and FOLFOX6 and 30% of patients treated with Erbitux and FOLFIRI.
These outcomes are better than what has been observed in the past and suggest that the combination of Erbitux and chemotherapy may be effective for patients with unresectable liver metastases from colorectal cancer.
Reference: Folprecht G, Gruenberger T, Bechstein WO et al. Tumour response and secondary respectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomized phase 2 trial. Lancet Oncology [early online publication]. November 25, 2009.
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