Trial confirms central role of irinotecan in mCRC

Data presented for the first time in Europe has reinforced the position of irinotecan as a key component of first line therapy in the management of patients with metastatic colorectal cancer (mCRC), Pfizer said.

Colorectal cancer is the most common cancer in Europe, and the third most common cancer worldwide. However, it is preventable in most cases and highly treatable if diagnosed in its early stages.

'Metastatic disease means patients need a lot of treatment, so we need to consider how well they can cope with each element of therapy. FOLFIRI is an important regimen of choice throughout the world, due to its tolerability as well as its efficacy, and is a valuable backbone on which to deliver targeted therapies to patients,' said Markus Moehler, assistant professor for GI Oncology, Johannes Gutenberg University, Mainz, Germany.

The Crystal trial evaluated cetuximab combined with the irinotecan-based chemotherapy regimen FOLFIRI versus FOLFIRI alone, in patients with metastatic colorectal cancer. Results showed that the risk of cancer spreading or growing was reduced by 15% for patients in the FOLFIRI plus cetuximab arm (p=0.0479), and that significantly more patients in this arm experienced a shrink in tumour size (46.9% versus 38.7% in the FOLFIRI only arm, p=0.0038).

Furthermore, in a subgroup analysis of patients who had liver-limited disease (patients who had liver metastases only), the positive effect of the addition of cetuximab was even more pronounced, resulting in a progression-free survival of 11.4 months with cetuximab versus 9.2 months in the control arm, and a 36% reduction in the risk of metastatic colorectal cancer growing or spreading. The number of complete resections of the metastases in the subgroup who had liver metastases only was more than double with cetuximab plus FOLFIRI versus the control arm (9.8% versus 4.5%). The number of complete resections in the overall population was three times higher in the cetuximab plus FOLFIRI arm.

'The results of this trial confirm the benefits of improving and refining treatment regimens to get better patient outcomes,'continued Moehler, who participated actively in the trial.