Biweekly cetuximab in combination with capecitabine and oxaliplatin (XELOX) or irinotecan (XELIRI) in patients with metastatic colorectal cancer


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Jamal Zekri1,Ehab Mosaad2,Refaei Belal Ibrahim3,Kamel Mohamed Kamal4,Adnan Hussain5,Mohammed Abbas Baghdadi6
1College of Medicine, Al-Faisal University, King Faisal Specialist Hospital (Jeddah),2Medical oncology department, National Cancer Institute, Cairo University,3Department of clinical oncology and nuclear medicine. Faculty of medicine Al Azhar University,4Cairo University,5King Faisal Specialist Hospital and Research Center- Jeddah,6Research Centre, King Faisal Specialist Hospital & Research Centre, Jeddah

Abstract

Background

Oral capecitabine (XEL) in combination with intravenous oxaliplatin (XELOX) and Irinotecan (XELIRI) are acceptable substitutions to all intravenous regimens (FOLFOX & FOLFIRI). Cetuximab is usually administered weekly. However, biweekly administration is more convenient when combined with biweekly chemotherapy. We aim to report the efficacy of biweekly cetuximab in combination with biweekly XELOX or XELIRI in patients with metastatic colorectal cancer (mCRC)

Method

Clinical data of all consecutive patients with mCRC who received biweekly cetuximab (500 mg/m2) with XELOX or XELIRI were identified and reviewed retrospectively. Doses of XEL was 1000 mg/m2 twice daily for 9 days, oxaliplatin 85 mg/m2 on day 1 and irinotecan 180 mg/m2 on day 1. Data on treatment dose reduction and delay for ≥7 days was captured and analyzed as a surrogate to tolerability and toxicity

Results

Seventy patients were included. Both KRAS and NRAS were wild type (WT) in 38 (54.3%) while KRAS was WT and NRAS not tested in 32 (45.7%) patients. XELOX was administered to 29 (41.4%) and XELIRI to 41 (58.6%) of patients. Median age was 54 (24-75) years. Chemotherapy component dose reduction and delay was observed in 15 (21.4%) and 20 (28.6%) patients respectively. The corresponding frequency for cetuximab was 2 (2.9%) and 30 (42.9%). Objective response rates, progression free survival and overall survival are summarized in the table below.

 

First line

Second line

Third line

Number

33

29

8

Radiological objective response

20 (60.61%),

13 (44.83%)

2 (25%)

Median Progression free survival (months)

8

 

6

 

3

 

Median overall survival (months)

21

 

16

 

7

 

Conclusion

In patients with KRAS or KRAS-NRAS WT mCRC, biweekly cetuximab in combination with XELOX or XELIRI is tolerable and has a manageable toxicity profile. The efficacy of these schedules is comparable to other established schedules considering the heterogeneous population treated in our routine clinical practice