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Yamazaki K, Yuki S, Oki E, Sano F, Makishima M, Aoki K, Hamano T, Yamanaka T. Real-World Evidence on Second-Line Treatment of Metastatic Colorectal Cancer Using Fluoropyrimidine, Irinotecan, and Angiogenesis Inhibitor. Clin Colorectal Cancer 2021; 20:e173-e184. [PMID: 33875364 DOI: 10.1016/j.clcc.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Combination therapy comprised of fluoropyrimidine plus irinotecan with an angiogenesis inhibitor is widely used as a second-line treatment for metastatic colorectal cancer (mCRC). PATIENTS AND METHODS This retrospective study evaluated the efficacy and safety of fluorouracil and irinotecan (FOLFIRI) plus ramucirumab (RAM); FOLFIRI plus aflibercept (AFL); irinotecan and S-1 (IRIS) plus bevacizumab (BEV); and capecitabine and irinotecan (CAPIRI) plus BEV, with FOLFIRI plus BEV serving as the control among mCRC patients who failed treatment with fluoropyrimidine and oxaliplatin plus BEV. Data were collected from a medical claim database provided by Medical Data Vision Co., Ltd. (Tokyo, Japan). The primary outcome was time to treatment failure (TTF). Secondary outcomes were time to first subsequent therapy (TFST), overall survival (OS), and safety. RESULTS Among 3,136 patients assessed, TTF was significantly shorter with FOLFIRI plus RAM (adjusted hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.26-1.56; P < .001) and FOLFIRI plus AFL (HR, 1.34; 95% CI, 1.09-1.66; P = .002), and significantly longer with IRIS plus BEV (HR, 0.80; 95% CI, 0.70-0.92; P = .002). TFST was significantly shorter with FOLFIRI plus RAM (HR, 1.32; 95% CI, 1.17-1.49; P < .001); no significant difference in OS was observed. The incidences of neutropenia requiring granulocyte colony-stimulating factor were significantly lower with IRIS plus BEV and CAPIRI plus BEV. CONCLUSION Regarding TTF, BEV seemed to be a favorable option compared with RAM and AFL when combined with FOLFIRI, and IRIS might be preferable compared to FOLFIRI when combined with BEV for patients who failed to respond to fluoropyrimidine, oxaliplatin, and BEV.
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Affiliation(s)
- Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Satoshi Yuki
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumikazu Sano
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Misako Makishima
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Kenichi Aoki
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | | | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
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Precision Approaches in the Management of Colorectal Cancer: Current Evidence and Latest Advancements Towards Individualizing the Treatment. Cancers (Basel) 2020; 12:cancers12113481. [PMID: 33238500 PMCID: PMC7700522 DOI: 10.3390/cancers12113481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
The genetic and molecular underpinnings of metastatic colorectal cancer have been studied for decades, and the applicability of these findings in clinical decision making continues to evolve. Advancements in translating molecular studies have provided a basis for tailoring chemotherapeutic regimens in metastatic colorectal cancer (mCRC) treatment, which have informed multiple practice guidelines. Various genetic and molecular pathways have been identified as clinically significant in the pathogenesis of metastatic colorectal cancer. These include rat sarcoma (RAS), epithelial growth factor receptor (EGFR), vascular endothelial growth factor VEGF, microsatellite instability, mismatch repair, and v-raf murine sarcoma viral oncogene homolog b1 (BRAF) with established clinical implications. RAS mutations and deficiencies in the mismatch repair pathway guide decisions regarding the administration of anti-EGFR-based therapies and immunotherapy, respectively. Furthermore, there are several emerging pathways and therapeutic modalities that have not entered mainstream use in mCRC treatment and are ripe for further investigation. The well-established data in the arena of targeted therapies provide evidence-based support for the use or avoidance of various therapeutic regimens in mCRC treatment, while the emerging pathways and platforms offer a glimpse into the future of transforming a precision approach into a personalized treatment.
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Debeuckelaere C, Murgioni S, Lonardi S, Girardi N, Alberti G, Fano C, Gallimberti S, Magro C, Ahcene-Djaballah S, Daniel F, Fassan M, Prenen H, Loupakis F. Ramucirumab: the long and winding road toward being an option for mCRC treatment. Expert Opin Biol Ther 2019; 19:399-409. [PMID: 30917706 DOI: 10.1080/14712598.2019.1600505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the main causes of cancer-related morbidity and mortality worldwide. Mortality is most often attributable to metastatic disease. Despite the progress achieved so far, life expectancy continues to be limited in most patients. Ramucirumab, a most recent antiangiogenic drug, is vying in the race to metastatic CRC (mCRC) treatment since its approval by the Food and Drug Administration (FDA), based on the results of the RAISE study. AREAS COVERED This article reviews the role of ramucirumab in mCRC, including clinical indication, safety issues, and future perspectives. EXPERT OPINION The use of Ramucirumab in clinical practice is still limited, probably due to economic burden and the lack of specific biomarkers. Future efforts will be addressed to improve our knowledge in the use of this drug and better guide us in patients' care.
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Affiliation(s)
| | - Sabina Murgioni
- b Department of Oncology, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
| | - Sara Lonardi
- b Department of Oncology, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
| | - Noemi Girardi
- c Department of Surgery, Oncology and Gastroenterology , University of Padua , Padua , Italy
| | - Giulia Alberti
- b Department of Oncology, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
- c Department of Surgery, Oncology and Gastroenterology , University of Padua , Padua , Italy
| | - Carolina Fano
- d Research Nurses Coordinating Center, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
| | - Sara Gallimberti
- d Research Nurses Coordinating Center, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
| | - Cristina Magro
- d Research Nurses Coordinating Center, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
| | - Selma Ahcene-Djaballah
- b Department of Oncology, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
| | - Francesca Daniel
- b Department of Oncology, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
- e Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine , S. Anna University Hospital , Ferrara , Italy
| | - Matteo Fassan
- f Department of Medicine, Pathology and Cytopathology Unit , Padua University Hospital , Padua , Italy
| | - Hans Prenen
- a Department of Oncology , University Hospital Antwerp , Edegem , Belgium
- g Center for Oncological Research , Antwerp University , Edegem , Belgium
| | - Fotios Loupakis
- b Department of Oncology, Unit of Oncology 1 , Veneto Institute of Oncology, Scientific Institute for Research and Healthcare (IRCCS) , Padua , Italy
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