Anti‑EGFR treatment of colorectal cancer

03-2021

MUDr. Stanislav Batko

Onkologická klinika 2. LF UK a FN v Motole, Praha

SUMMARY

Treatment of metastatic colorectal cancer is based on the combination of chemotherapy and targeted therapy, in which anti-EGFR monoclonal antibodies cetuximab and panitumumab play a very important role in RAS + BRAF wild-type subgroup of patients. They have showed prolonged progression-free survival throughout all lines, with prolongation of overall survival demonstrated in first- and third-line studies. The most significant benefit in overall survival can be observed, when they are used in chemonaive metastatic colorectal cancer. In this setting anti-EGFR (epidermal growth factor receptor) therapies pro- vide deep and durable response. This effect of tumor mass reduction simultaneously allows a significant proportion of patients to achieve conversion and secondary resection of metastases associated with longer survival and potential for curability. In addition to the most commonly used doublets FOLFOX and FOLFIRI, panitumumab can be used in combination with 5-fluorouracil and leucovorin in elderly patients while maintaining its efficacy. At the same time, there is increasing experience with the use of anti-EGFR therapies in combination with the FOLFOXIRI triplet, demonstrating high potential to achieve resectability. The indication criteria have been newly expanded to include BRAF V600E mutated pre- treated metastatic colorectal cancer, where the combination of cetuximab with encorafenib resulted in a significant prolongation of overall survival.

Key words

metastatic colorectal carcinoma, anti-EGFR, panitumumab, cetuximab