ModifiedFOLFOXIRIWith or Without Cetuximab as Conversion Therapy in Patients withRAS/BRAFWild-TypeUnresectable Liver Metastases Colorectal Cancer: TheFOCULMMulticenter PhaseIITrial

Purpose This trial evaluated the addition of cetuximab to a modified FOLFOXIRI (mFOLFOXIRI: 5-fluorouracil/folinic acid, oxaliplatin, irinotecan) as conversion therapy in a two-group, nonrandomized, multicenter, phase II trial in patients with initially technically unresectable colorectal liver-limited metastases (CLM) andBRAF/RASwild-type. Patients and Methods Patients were enrolled to receive cetuximab (500 mg/m(2)) plus mFOLFOXIRI (oxaliplatin 85 mg/m(2), irinotecan 165 mg/m(2), folinic acid 400 mg/m(2), 5-fluorouracil 2,800 mg/m(2)46-hour infusion, every 2 weeks) (the cetuximab group) or the same regimen of mFOLFOXIRI alone (the control group), in a 2:1 ratio allocation. The primary endpoint was the rate of no evidence of disease (NED) achieved. Secondary endpoints included resection rate, objective response rate (ORR), survival, and safety. Results Between February 2014 and July 2019, 117 patients were registered for screening at six centers in China, and 101 of these were enrolled (67 cetuximab group, 34 control group). The rate of NED achieved was 70.1% in the cetuximab group and 41.2% in the control group (difference 29.0%; 95% confidence interval [CI], 9.1%-48.8%;p= .005). Patients in the cetuximab group had improved ORR (95.5% vs. 76.5%; difference 19.1%; 95% CI, 17.4%-36.4%;p= .010) compared with those in control group. Progression-free survival and overall survival showed the trend to favor the cetuximab group. The incidence of grade 3 and 4 adverse events was similar in the two groups. Conclusion Addition of cetuximab to mFOLFOXIRI improved the rate of NED achieved. This combination could be an option of conversion regimen for molecularly selected patients with initially technically unresectable CLM. Implications for Practice This trial evaluated the addition of cetuximab to a modified FOLFOXIRI as conversion therapy in a phase II trial in patients with initially technically unresectable colorectal liver-limited metastases andBRAF/RASwild-type. The rate of no evidence of disease achieved was 70.1% in the cetuximab plus modified FOLFOXIRI group and 41.2% in the modified FOLFOXIRI group. Objective response rates, overall survival, and progression-free survival were improved in the cetuximab group when compared with the modified FOLFOXIRI group. Addition of cetuximab to modified FOLFOXIRI increased the rate of no evidence of disease achieved, and this combination could be an option of conversion regimen for molecularly selected patients with initially technically unresectable colorectal liver-limited metastasis.

Automated summary

This trial evaluated the addition of cetuximab to a modified FOLFOXIRI as conversion therapy in patients with initially unresectable colorectal liver-limited metastases. The addition of cetuximab improved the rate of no evidence of disease achieved, as well as objective response rates, overall survival, and progression-free survival. This combination could be a viable option for molecularly selected patients with initially unresectable colorectal liver-limited metastasis.