A multi-center phase II study and biomarker analysis of combined cetuximab and modified FOLFIRI as second-line treatment in patients with metastatic gastric cancer

A multi-center phase II study and biomarker analysis of combined cetuximab and modified FOLFIRI as second-line treatment in patients with metastatic gastric cancer

BMC Cancer, March 2017

28288572

Xin Liu, Weijian Guo, Wen Zhang, Jiliang Yin, Jun Zhang, Xiaodong Zhu, Tianshu Liu, Zhiyu Chen, Biyun Wang, Jianhua Chang, Fangfang Lv, Xiaonan Hong, Huijie Wang, Jialei Wang, Xinmin Zhao, Xianghua Wu, Jin Li

To evaluate the efficacy of cetuximab combined with modified FOLFIRI (mFOLFIRI) as a second-line treatment in metastatic gastric cancer patients and to identify potential biomarkers of clinical outcomes. All 61 patients received an initial intravenous (IV) dose of cetuximab (400 mg/m(2)) and weekly doses (250 mg/m(2)) thereafter, starting on day 1. On day 2 of each 14-day period, patients received IV irinotecan (180 mg/m(2)), leucovorin (200 mg/m(2)), and an IV bolus dose of 5-FU (400 mg/m(2)) followed by a continuous infusion of 5-FU (2400 mg/m(2)) for 46 h. The primary endpoint was time-to-progression (TTP). The response rate (RR) was 33.3% among 54 evaluable patients. In the intention-to-treat analysis, median TTP was 4.6 months (95% confidential interval [CI]: 3.6-5.6 months) and median overall survival (OS) was 8.6 months (95% CI: 7.3-9.9 months). In univariate analyses, plasma vascular endothelial growth factor (VEGF) levels were correlated with clinical outcome. In patients with low (≤12.6 pg/ml) and high (>12.6 pg/ml) baseline plasma VEGF levels, RR values were 55.0% and 5.3%, respectively (P = 0.001); median TTP values were 6.9 months and 2.8 months, respectively (P = 0.0005); and median OS values were 12 months and 5 months, respectively (P <0.0001). None of these patients exhibited KRAS, BRAF, or PIK3CA mutations. Combination therapy comprising cetuximab and mFOLFIRI was well tolerated and active as a second-line treatment for patients with metastatic gastric cancer. Patients with low baseline plasma VEGF levels were associated with better clinical outcomes. ClinicalTrials.gov. NCT00699881 . Registered 17 June 2008 (retrospectively registered).