Will you give perioperative chemotherapy with EGFR inhibitors for stage IV left-sided RAS/BRAF WT colorectal cancer with resectable/borderline resectable liver metastases given discordant PARADIGM vs New EPOC trial results?
How do you reconcile the differences between the two studies?
Answer from: Medical Oncologist at Academic Institution
EPOC trial randomized patients with KRAS wild type and resectable or near-resectable metastatic liver disease to FOLFOX vs. FOLFOX/cetuximab. Long term follow-up data significant for PFS of 22·2 months (95% CI 18·3-26·8) in the FOLFOX group and 15·5 months (13·8-19...
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Answer from: Medical Oncologist at Academic Institution
This is a very controversial topic/discussion.The New EPOC study was a multicenter, open label, randomized phase 3 study that enrolled 257 patients with KRAS wild-type resectable or suboptimally resectable colorectal liver metastatic disease. Patients were randomized to systemic chemotherapy with or...
Answer from: Medical Oncologist at Academic Institution
No. I don't give perioperative EGFRi when patients have oligometastatic CRC to the liver. New EPOC and other smaller noncomparative reports of worse outcomes following metastasectomy when exposed preoperatively to EGFRi, despite better initial responses when combining chemo with EGFRi (as in, median...
Answer from: Medical Oncologist at Community Practice
Tumor subsite seems to influence the treatment choices in patients with wild-type RAS colorectal cancer with benefits seen from anti-EGFR therapy primarily in those with left-sided or distal tumors. A pooled analysis of 5 randomized first-line trials (FIRE-3, CRYSTAL, PRIME, PEAK, and CALGB/SWOG 804...