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- Withholding the Introduction of Anti‐Epidermal Growth Factor Receptor: Impact on Outcomes in RAS Wild‐Type Metastatic Colorectal Tumors: A Multicenter AGEO Study (the WAIT or ACT Study)
Withholding the Introduction of Anti‐Epidermal Growth Factor Receptor: Impact on Outcomes in RAS Wild‐Type Metastatic Colorectal Tumors: A Multicenter AGEO Study (the WAIT or ACT Study)
Auteurs
Lola‐Jade Palmieri, Laurent Mineur, David Tougeron, Benoît Rousseau, Victoire Granger, Jean‐Marc Gornet, Denis Smith, Astrid Lievre, Marie‐Pierre Galais, Solene Doat, Simon Pernot, Anne‐Laure Bignon‐Bretagne, Jean‐Philippe Metges, Nabil Baba‐Hamed, Pierre Michel, Stéphane Obled, Carole Vitellius, Olivier Bouche, Léa Saban‐Roche, Bruno Buecher, Gaëtan des Guetz, Christophe Locher, Isabelle Trouilloud, Gaël Goujon, Marie Dior, Sylvain Manfredi, Emilie Soularue, Jean‐Marc Phelip, Julie Henriques, Dewi Vernery, Romain Coriat
Résumé
Abstract
Background
Patients with RAS wild-type (WT) nonresectable metastatic colorectal cancer (mCRC) may receive either bevacizumab or an anti-epidermal growth factor receptor (EGFR) combined with first-line, 5-fluorouracil-based chemotherapy. Without the RAS status information, the oncologist can either start chemotherapy with bevacizumab or wait for the introduction of the anti-EGFR. Our objective was to compare both strategies in a routine practice setting.
Materials and Methods
This multicenter, retrospective, propensity score–weighted study included patients with a RAS WT nonresectable mCRC, treated between 2013 and 2016 by a 5-FU-based chemotherapy, with either delayed anti-EGFR or immediate anti-vascular endothelial growth factor (VEGF). Primary criterion was overall survival (OS). Secondary criteria were progression-free survival (PFS) and objective response rate (ORR).
Results
A total of 262 patients (129 in the anti-VEGF group and 133 in the anti-EGFR group) were included. Patients receiving an anti-VEGF were more often men (68% vs. 56%), with more metastatic sites (>2 sites: 15% vs. 9%). The median delay to obtain the RAS status was 19 days (interquartile range: 13–26). Median OS was not significantly different in the two groups (29 vs. 30.5 months, p = .299), even after weighting on the propensity score (hazard ratio [HR] = 0.86, 95% confidence interval [CI], 0.69–1.08, p = .2024). The delayed introduction of anti-EGFR was associated with better median PFS (13.8 vs. 11.0 months, p = .0244), even after weighting on the propensity score (HR = 0.74, 95% CI, 0.61–0.90, p = .0024). ORR was significantly higher in the anti-EGFR group (66.7% vs. 45.6%, p = .0007).
Conclusion
Delayed introduction of anti-EGFR had no deleterious effect on OS, PFS, and ORR, compared with doublet chemotherapy with anti-VEGF.