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Highlights in Metastatic Colorectal Cancer from the 2012 American July 2012 A SPECIAL MEETING REVIEW EDITION Volume 10, Issue 7, Supplement 9 Highlights in Metastatic Colorectal Cancer From the 2012 American Society of Clinical Oncology Annual Meeting June 1–5, 2012 • Chicago, Illinois Special Reporting on: • Bevacizumab (BEV) Plus Chemotherapy (CT) Continued Beyond First Progression in Patients With Metastatic Colorectal Cancer (mCRC) Previously Treated With BEV Plus CT: Results of a Randomized Phase III Intergroup Study (TML Study) • Bevacizumab (Bev) With or Without Erlotinib as Maintenance Therapy, Following Induction First-Line Chemotherapy Plus Bev, in Patients (Pts) With Metastatic Colorectal Cancer (MCRC): Efficacy and Safety Results of the International GERCOR DREAM Phase III Trial • Results of the X-PECT Study: A Phase III Randomized Double-Blind, Placebo-Controlled Study of Perifosine Plus Capecitabine (P-CAP) Versus Placebo Plus Capecitabine (CAP) in Patients (Pts) With Refractory Metastatic Colorectal Cancer (mCRC) • Phase III CORRECT Trial of Regorafenib in Metastatic Colorectal Cancer (mCRC) • Final Analysis of the Phase III Randomized Trial of Cetuximab (CET) Plus Either Brivanib Alaninate (BRIV) or Placebo in Patients (pts) With Chemotherapy Refractory, K-RAS Wild-Type (WT), Metastatic Colorectal Carcinoma (mCRC): The NCIC Clinical Trials Group and AGITG CO.20 trial • Effects of Prior Bevacizumab (B) Use on Outcomes From the VELOUR study: A Phase III Study of Aflibercept (Afl) and FOLFIRI in Patients (pts) With Metastatic Colorectal Cancer (mCRC) After Failure of an Oxaliplatin Regimen • FOLFOX4 (12 cycles) Versus Sequential Dose-Dense FOLFOX7 (6 cycles) Followed by FOLFIRI (6 cycles) in Patients With Initially Resectable Metastatic Colorectal Cancer: A GERCOR Random- ized Phase III Study (MIROX) PLUS Meeting Abstract Summaries With Expert Commentary by: Axel Grothey, MD Professor of Oncology Mayo Clinic Rochester, Minnesota ON THE WEB: www.clinicaladvances.com Indexed through the National Library of Medicine (PubMed/Medline), PubMed Central (PMC), and EMBASE S pecial meeting review edition Bevacizumab (BEV) Plus Chemotherapy (CT) Continued Beyond First Progression in Patients With Metastatic Colorectal Cancer (mCRC) Previously Treated With BEV Plus CT: Results of a Randomized Phase III Intergroup Study (TML Study) or patients with metastatic progression was independently associ- be at least 3 months. Finally, patients colorectal cancer (CRC) who ated with improved survival (hazard were required to have received first-line develop disease progression after ratio [HR], 0.48; P<.001).4 These bevacizumab for at least 3 months. Ffirst-line bevacizumab plus fluoropy- findings were confirmed in the ARIES For the study treatment, patients rimidine-based chemotherapy, continu- (Avastin [bevacizumab] Regimens: were switched to an opposite chemo- ing bevacizumab with the second-line Investigation of Treatment Effects and therapy regimen (oxaliplatin-based or chemotherapy regimen appears to Safety) observational cohort study, irinotecan-based) and were randomly provide a significant survival benefit, which showed a significant independent assigned to receive chemotherapy plus according to the randomized, phase III, improvement in the duration of survival bevacizumab 2.5 mg/kg/week (409 intergroup TML study presented by beyond first progression with continued patients) or chemotherapy alone (411 Dirk Arnold, MD.1 Dr. Arnold noted bevacizumab (HR, 0.41; P<.001).5 patients). The exact regimen used was that the addition of bevacizumab to Based on these observations, Arnold at the investigators’ discretion. Patients fluoropyrimidine-based chemotherapy and colleagues designed the randomized, were stratified based on the first-line che- is standard in the first-line treatment of phase III TML trial to evaluate the efficacy motherapy regimen (oxaliplatin-based vs metastatic CRC or in the second-line and safety of continuing bevacizumab irinotecan-based), duration of initial PFS setting for bevacizumab-naïve patients. with standard second-line chemotherapy (≤9 months vs >9 months), duration The use of bevacizumab in both the in patients with metastatic CRC who from last bevacizumab dose (≤42 days first-line and second-line therapies had have progressed after bevacizumab plus vs >42 days), and Eastern Cooperative not previously been evaluated in a phase standard first-line chemotherapy. The Oncology Group (ECOG) performance III trial. However, there is a scientific trial enrolled 820 patients with metastatic status at baseline (0–1 vs 2). The study rationale for continued bevacizumab; CRC who had received first-line bevaci- accrued patients between February 2006 in preclinical studies, sustained vascular zumab plus either oxaliplatin-based or and June 2010 at 200 study centers in endothelial growth factor (VEGF) inhi- irinotecan-based chemotherapy and had Europe and Saudi Arabia. The demo- bition has been shown to achieve and documented progressive disease within 4 graphic and baseline characteristics were maintain tumor regression.2,3 weeks of starting the study treatment. balanced between the arms. The median Moreover, several observational Patients had to have received age was 63 years; approximately 56% of cohort studies have demonstrated a bevacizumab within the past 3 patients had a first-line PFS at or within benefit with continuing bevacizumab months, reflecting a maximum dura- 9 months; approximately 58% had beyond first progression. In the BRiTE tion of bevacizumab interruption of received irinotecan-based chemotherapy (Bevacizumab Regimens: Investigation 3 months. Moreover, the duration in the first-line setting; and 77% had of Treatment Effects and Safety) study, of progression-free survival (PFS) in received their last bevacizumab dose continuing bevacizumab beyond first first-line treatment was required to within 42 days. Disclaimer Every effort has been made to ensure that drug usage and other information are presented accurately; however, the ultimate responsibility rests with the prescribing physician. Millennium Medical Publishing, Inc, and the participants shall not be held responsible for errors or for any consequences arising from the use of information contained herein. Readers are strongly urged to consult any relevant primary literature. No claims or endorsements are made for any drug or compound at present under clinical investigation. ©2012 Millennium Medical Publishing, Inc., 611 Broadway, Suite 310, New York, NY 10012. Printed in the USA. All rights reserved, including the right of reproduction, in whole or in part, in any form. 2 Clinical Advances in Hematology & Oncology Volume 10, Issue 7, Supplement 9 July 2012 H ighlights in M etastatic C olorectal C ancer F rom the 2012 ASCO M eeting significant improvement in OS com- Randomized Phase III Study of Adjuvant Chemotherapy With Oral pared with chemotherapy alone, with Uracil and Tegafur Plus Leucovorin Versus Intravenous Fluorouracil a median OS of 11.1 months and 9.6 and Levofolinate in Patients (pts) With Stage III Colon Cancer (CC): months, respectively (unstratified HR, Final Results of Japan Clinical Oncology Group Study (JCOG0205) 0.81; P=.0062). Outcomes were similar in a stratified analysis, yielding a HR of For patients with stage III CRC cancer, postoperative adjuvant chemotherapy with oral 0.83 (P=.0211). Prespecified subgroup uracil-tegafur plus leucovorin appears to be noninferior to intravenous 5-FU plus levofo- analyses showed a similar OS benefit linate, according to the final results of the randomized, phase III Japan Clinical Oncology with bevacizumab across subgroups. Group Study 0205 (Abstract 3524). In the trial, 1,101 patients aged 20–75 years with stage Although there was no significant III CRC were randomly assigned to postoperative uracil-tegafur (300 mg/m2/day) plus benefit with bevacizumab in female leucovorin (75 mg/day) on Days 1–28 every 5 weeks for 5 courses (551 patients) or 5-FU patients, a treatment-sex interaction (500 mg/m2) plus levofolinate (250 mg/m2) on Days 1, 8, 15, 22, 29, and 36 every 8 weeks test showed no significant interaction for 3 courses (550 patients). After a median follow-up of 72 months, oral uracil-tegafur between the benefit of bevacizumab demonstrated noninferiority to 5-FU plus levofolinate (HR, 1.02; P=.0236). Overall dis- and sex. Approximately 68% of patients ease-free survival rates were 78.6% at 3 years and 74% at 5 years. The 5-year OS rate was went on to receive at least 1 subsequent high at 87.9%; the investigators suggested the use of D3 dissection and upstaging with anticancer therapy; there were no nota- careful lymph node examination as potential explanations. The most common grade 3/4 ble differences between the 2 arms in adverse events were diarrhea (8.5% with uracil-tegafur plus leucovorin vs 9.6% with 5-FU the frequency of subsequent therapies plus levofolinate), ALT elevation (8.7% vs 0.7%), and neutropenia (1.5% vs 8.4%). or the types of therapies used. Bevacizumab plus chemotherapy was also more effective than chemo- 1.0 therapy alone in regard to median PFS (5.7 vs 4.1 months; unstratified CT (n=410) 0.8 HR, 0.68; P<.0001; Figure 1). There BEV + CT (n=409) was no significant difference in overall 0.6 response rate between arms (5.4% and 3.9%, respectively). However, bevaci- 0.4 zumab plus chemotherapy was associ- ated with a significant improvement PFS Estimate 0.2 in disease control rate versus chemo- therapy alone (68% vs 54%; P<.0001). 0 The investigators reported no signif- 0 6 12 18 24 30 36 42 icant difference in the incidence
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