TY - JOUR
T1 - Phase III Trial of Cetuximab With Continuous or Intermittent Fluorouracil, Leucovorin, and Oxaliplatin (Nordic FLOX) Versus FLOX Alone in First-Line Treatment of Metastatic Colorectal Cancer
T2 - The NORDIC-VII Study
AU - Tveit, Kjell Magne
AU - Guren, Tormod
AU - Glimelius, Bengt
AU - Pfeiffer, Per
AU - Sorbye, Halfdan
AU - Pyrhonen, Seppo
AU - Sigurdsson, Fridbjorn
AU - Kure, Elin
AU - Ikdahl, Tone
AU - Skovlund, Eva
AU - Fokstuen, Tone
AU - Hansen, Flemming
AU - Hofsli, Eva
AU - Birkemeyer, Elke
AU - Johnsson, Anders
AU - Starkhammar, Hans
AU - Yilmaz, Mette Karen
AU - Keldsen, Nina
AU - Erdal, Anne Berit
AU - Dajani, Olav
AU - Dahl, Olav
AU - Christoffersen, Thoralf
PY - 2012
Y1 - 2012
N2 - PURPOSEThe NORDIC-VII multicenter phase III trial investigated the efficacy of cetuximab when added to bolus fluorouracil/folinic acid and oxaliplatin (Nordic FLOX), administered continuously or intermittently, in previously untreated metastatic colorectal cancer (mCRC). The influence of KRAS mutation status on treatment outcome was also investigated. PATIENTS AND METHODSPatients were randomly assigned to receive either standard Nordic FLOX (arm A), cetuximab and FLOX (arm B), or cetuximab combined with intermittent FLOX (arm C). Primary end point was progression-free survival (PFS). Overall survival (OS), response rate, R0 resection rate, and safety were secondary end points.ResultsOf the 571 patients randomly assigned, 566 were evaluable in intention-to-treat (ITT) analyses. KRAS and BRAF mutation analyses were obtained in 498 (88%) and 457 patients (81%), respectively. KRAS mutations were present in 39% of the tumors; 12% of tumors had BRAF mutations. The presence of BRAF mutations was a strong negative prognostic factor. In the ITT population, median PFS was 7.9, 8.3, and 7.3 months for the three arms, respectively (not significantly different). OS was almost identical for the three groups (20.4, 19.7, 20.3 months, respectively), and confirmed response rates were 41%, 49%, and 47%, respectively. In patients with KRAS wild-type tumors, cetuximab did not provide any additional benefit compared with FLOX alone. In patients with KRAS mutations, no significant difference was detected, although a trend toward improved PFS was observed in arm B. The regimens were well tolerated. CONCLUSIONCetuximab did not add significant benefit to the Nordic FLOX regimen in first-line treatment of mCRC.
AB - PURPOSEThe NORDIC-VII multicenter phase III trial investigated the efficacy of cetuximab when added to bolus fluorouracil/folinic acid and oxaliplatin (Nordic FLOX), administered continuously or intermittently, in previously untreated metastatic colorectal cancer (mCRC). The influence of KRAS mutation status on treatment outcome was also investigated. PATIENTS AND METHODSPatients were randomly assigned to receive either standard Nordic FLOX (arm A), cetuximab and FLOX (arm B), or cetuximab combined with intermittent FLOX (arm C). Primary end point was progression-free survival (PFS). Overall survival (OS), response rate, R0 resection rate, and safety were secondary end points.ResultsOf the 571 patients randomly assigned, 566 were evaluable in intention-to-treat (ITT) analyses. KRAS and BRAF mutation analyses were obtained in 498 (88%) and 457 patients (81%), respectively. KRAS mutations were present in 39% of the tumors; 12% of tumors had BRAF mutations. The presence of BRAF mutations was a strong negative prognostic factor. In the ITT population, median PFS was 7.9, 8.3, and 7.3 months for the three arms, respectively (not significantly different). OS was almost identical for the three groups (20.4, 19.7, 20.3 months, respectively), and confirmed response rates were 41%, 49%, and 47%, respectively. In patients with KRAS wild-type tumors, cetuximab did not provide any additional benefit compared with FLOX alone. In patients with KRAS mutations, no significant difference was detected, although a trend toward improved PFS was observed in arm B. The regimens were well tolerated. CONCLUSIONCetuximab did not add significant benefit to the Nordic FLOX regimen in first-line treatment of mCRC.
U2 - 10.1200/JCO.2011.38.0915
DO - 10.1200/JCO.2011.38.0915
M3 - Journal article
SN - 0732-183X
VL - 30
SP - 1755
EP - 1762
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
ER -