Introduction: Bevacizumab Versus Cetuximab in mCRC

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Moderator Johanna Bendell, MD, introduces a panel discussion focused on the optimization of treatment for patients with metastatic colorectal cancer (mCRC). The conversation includes expert perspectives from Al B. Benson III, MD, Charles D. Blanke, MD, Axel Grothey, MD, Tanios S. Bekaii-Saab, MD, and Alan P. Venook, MD.

Results from the phase III CALGB/SWOG 80405 trial that compared frontline bevacizumab with cetuximab were presented in a plenary session at the 2014 ASCO Annual Meeting. In this study, investigators were allowed to utilize either FOLFIRI or FOLFOX as a chemotherapy backbone with the two biologic agents, notes Blanke. The primary endpoint of overall survival (OS) was similar between the two arms, at approximately 29 months.

Ten years ago, the trial was designed with a third arm that examined the combination of bevacizumab and cetuximab. However, subsequent studies demonstrated a lack of efficacy for the combination, resulting in the removal of this arm of the trial, notes Blanke.

The decision to allow both types of chemotherapy was based on findings from the randomized GERCOR study that was conducted by Tournigand, et al. This study compared frontline FOLFIRI followed by FOLFOX6 with the reverse sequence in patients with advanced CRC. In an analysis of the findings, response rates, progression-free survival, and OS were similar for the two chemotherapy regimens. The median OS for each arm was approximately 21 months.