一项 FOLFIRI{+/-}panitumumab 二线治疗转移性结直肠癌的随机 3 期研究的最终结果。

Final results from a randomized phase 3 study of FOLFIRI {+/-} panitumumab for second-line treatment of metastatic colorectal cancer.

机构信息

Department of Oncology, University Hospital Antwerp, Antwerp, Belgium.

出版信息

Ann Oncol. 2014 Jan;25(1):107-16. doi: 10.1093/annonc/mdt523.

Abstract

BACKGROUND

The study 20050181 demonstrated significant improvements in progression-free survival (PFS), objective response, and a nonsignificant trend toward increased overall survival (OS) with panitumumab-FOLFIRI versus FOLFIRI alone for second-line wild-type (WT) KRAS metastatic colorectal cancer (mCRC). Updated long-term data from a prespecified descriptive analysis are reported.

PATIENTS AND METHODS

Patients receiving one prior mCRC treatment were randomly assigned (1:1) to panitumumab (6.0 mg/kg)-FOLFIRI versus FOLFIRI every 2 weeks. Co-primary end points (PFS and OS) were prospectively analyzed by tumor KRAS status.

RESULTS

One thousand one hundred and eighty-six patients were randomly assigned. In patients with WT KRAS tumors, panitumumab-FOLFIRI significantly improved PFS versus FOLFIRI [median 6.7 versus 4.9 months; hazard ratio (HR) 0.82 [95% confidence interval (CI) 0.69, 0.97]; P = 0.023]. A trend toward longer OS was observed (median 14.5 versus 12.5 months; HR 0.92 [95% CI 0.78, 1.10]; P = 0.37). Response rates improved from 10% to 36% (P < 0.0001). From post hoc analyses in patients receiving prior oxaliplatin-bevacizumab, panitumumab-FOLFIRI improved PFS (median 6.4 versus 3.7 months; HR 0.58 [95% CI 0.37, 0.90]; P = 0.014). PFS and OS appeared longer for worst-grade skin toxicity of 2-4, versus 0-1 or FOLFIRI. Safety results were as previously reported and consistent with the known toxicities with anti-epidermal growth factor receptor therapy.

CONCLUSIONS

These data confirm the primary efficacy and safety findings of this trial and support panitumumab-FOLFIRI as a second-line treatment of WT KRAS mCRC.

摘要

背景

研究 20050181 表明,与单独使用 FOLFIRI 相比,帕尼单抗联合 FOLFIRI 二线治疗野生型(WT)KRAS 转移性结直肠癌(mCRC)可显著提高无进展生存期(PFS)、客观缓解率,且总生存期(OS)有增加的趋势,但无统计学意义。现报道预先设定的描述性分析的长期更新数据。

患者和方法

接受过一线 mCRC 治疗的患者按 1:1 随机分配(1:1)接受帕尼单抗(6.0mg/kg)联合 FOLFIRI 或每 2 周接受 FOLFIRI 治疗。主要终点(PFS 和 OS)按肿瘤 KRAS 状态进行前瞻性分析。

结果

共 1186 例患者随机分组。在 WT KRAS 肿瘤患者中,与 FOLFIRI 相比,帕尼单抗联合 FOLFIRI 可显著改善 PFS [中位 6.7 个月比 4.9 个月;风险比(HR)0.82(95%置信区间[CI]0.69,0.97);P=0.023]。OS 有延长趋势(中位 14.5 个月比 12.5 个月;HR 0.92(95%CI0.78,1.10);P=0.37)。缓解率从 10%提高到 36%(P<0.0001)。在既往接受奥沙利铂联合贝伐珠单抗治疗的患者中,帕尼单抗联合 FOLFIRI 可改善 PFS(中位 6.4 个月比 3.7 个月;HR 0.58(95%CI0.37,0.90);P=0.014)。3-4 级皮肤毒性的患者的 PFS 和 OS 似乎更长,而 0-1 级或接受 FOLFIRI 治疗的患者则更短。安全性结果与既往报道一致,与抗表皮生长因子受体治疗的已知毒性一致。

结论

这些数据证实了该试验的主要疗效和安全性发现,并支持帕尼单抗联合 FOLFIRI 作为 WT KRAS mCRC 的二线治疗方案。

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