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Triple Chemo Combo Improves CRC Outcomes

(SWOG) Dec 23, 2020 - Researchers from SWOG Cancer Research Network, a cancer clinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health, have shown that a triple drug combination – of irinotecan, cetuximab, and vemurafenib – is a more powerful tumor fighter and keeps people with metastatic colon cancer disease free for a significantly longer period of time compared with patients treated with irinotecan and cetuximab.

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Howard S. Hochster, MD (Posted: January 05, 2021)

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S1406 was a randomized phase II study of 100 patients with RAS wt, BRAF V600E mutated CRC in 2nd-3rd line therapy of metastatic CRC. In this setting with pretreated disease, patient were randomized to IC (Irinotecan and Cetuximab) vs ICV (same plus vemurafenib). The addition of vemurafenib increased PFS from 2.0 to 4.2 months, and Response Rate from 4% to 17%. For serial ctDNA measurement, 88% of the ICV patients showed decrease in %V600E ctDNA compared with 0% in the IC arm. Patients in the IC arm crossed over to the ICV arm and had similar benefit with med PFS of 5.6 mos. This clearly shows that addition of a BRAF inhibitor with antiEGFR adds considerably to treatment of patients with BRAF mutated CRC. Similar benefit was seen after IC alone. The addition of chemotherapy here is of uncertain benefit, but is in the same range as seen with the BEACON study. This is a very active regimen and can be considered for treatment of those patients with BRAFm pre-treated CRC.

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