Patients with initially unresectable CRLM might qualify for local treatment with curative intent after reducing the tumour size by induction systemic treatment. The current phase 3 CAIRO5 trial (NCT02162563) aimed to find the optimal systemic induction regimen to convert initially unresectable CRLM to local treatment in 121 participants. Previously, it was reported that the progression-free survival was significantly longer and the complete local treatment (R0/R1 resection and/or ablation) higher with FOLFOXIRI (arm A) versus FOLFOX/FOLFIRI (arm B), both plus bevacizumab for participants with right-sided and/or RAS/BRAFV600E-mutated tumours [1]. For patients with left-sided and RAS/BRAF V600 wildtype tumours, these parameters were not different between adding bevacizumab (arm C) versus panitumumab (arm D) to FOLFOX/FOLFIRI. Prof. Cornelis J. Punt (University Medical Center Utrecht, the Netherlands) presented the OS results from the CAIRO5 trial [2].
The median follow-up was 58 months and the median OS in arm A versus B was 23.6 months versus 24.1 months (HR 0.92; 95% CI 0.70–1.20; P=0.52). In both arms A and B, OS in participants who had local treatment was significantly longer than OS in participants without local treatment (HR 0.27 vs 0.30 in arm A vs arm B, respectively). The median OS in arm C versus D was 40.4 months versus 38.3 months (HR 1.02; 95% CI 0.72–1.46; P=0.89). As for arms A and B, OS in participants who had local treatment in arms C and D was significantly better compared with participants without local treatment (HR 0.22 and HR 0.19). Recurrence within 6 months after complete local treatment occurred in 49% versus 39% of participants in arm A versus B (P=0.28), and 42% versus 39% of participants in arm C versus D (P=0.73).
“In this first randomised study to prospectively evaluate 4 systemic induction regimens in participants with initially unresectable CRLM, no benefit in median OS was observed
between FOLFOXIRI-bevacizumab and FOLFOX/FOLFIRI-bevacizumab for right-sided and/or RAS/BRAFV600E-mutated tumours, nor between adding panitumumab versus bevacizumab to FOLFOX/FOLFIRI for left-sided and RAS/BRAF V600 wildtype tumours,” concluded Prof. Punt.
- Bond MJG, et al. Lancet Oncol. 2023;24(7):757–771.
- Punt CJ, et al. First-line systemic treatment in patients with initially unresectable colorectal cancer liver metastases (CRLM): overall survival of the phase III CAIRO5 study of the Dutch Colorectal Cancer Group. Abstract LBA27, ESMO 2023, 20-24 October, Madrid, Spain.
Copyright ©2023 Medicom Medical Publishers
Posted on