Role of Cetuximab Re-introduction and Re-challenge in Later Lines of Treatment in Metastatic Colorectal Cancer: A Case Series

Amrou Shaaban ( Kuwait Cancer Control Centre, Shuwaikh, Kuwait )

Asit Mohanty

Yousef Abo Eseud

Jasem Albarrak

https://doi.org/10.37155/2717-5278-0202-4

Abstract

Colorectal cancer (CRC) is the third-largest cancer in the world and has the second-highest mortality rate, characterized by poor prognosis and high metastasis. The early symptoms of CRC are mostly inconspicuous and it is usually diagnosed in the advanced stages. Nearly half of the patients diagnosed with metastatic colorectal cancer (mCRC) are inoperable and have high chances of recurrence and metastasis. Combination therapy with cetuximab and chemotherapy is considered the first-line treatment for mCRC. In patients with Kirsten RAt Sarcoma wild-type mCRC, re-challenge and maintenance therapy with cetuximab was found to be beneficial. However, the disease progression is inevitable. This paper discusses three different cases of metastatic adenocarcinoma in the colon and rectum treated with the re-introduction and re-challenge of cetuximab in combination with chemotherapy. The treatment was found to be effective in treating mCRC in later lines of therapy where treatment options are scarce.

Keywords

cetuximab; chemotherapy; metastatic disease; colorectal cancer; re-challenge; re-introduction

Full Text

PDF

References

[1].Salvatore L, Aprile G, Arnoldi E, Aschele C, Carnaghi C, Cosimelli M, et al. Management of metastatic colorectal cancer patients: guidelines of the Italian Medical Oncology Association (AIOM). ESMO Open. 2017;2(1):e000147.
[2].Rawla P, Barsouk A, Hadjinicolaou AV, Barsouk A. Immunotherapies and Targeted Therapies in the Treatment of Metastatic Colorectal Cancer. Med Sci (Basel). 2019;7(8).
[3].Segelov E, Chan D, Shapiro J, Price TJ, Karapetis CS, Tebbutt NC, et al. The role of biological therapy in metastatic colorectal cancer after first-line treatment: a meta-analysis of randomised trials. Br J Cancer. 2014;111(6):1122-31.
[4].Leto SM, Trusolino L. Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies. J Mol Med (Berl). 2014;92(7):709-22.
[5].Goldberg RM, Montagut C, Wainberg ZA, Ronga P, Audhuy F, Taieb J, et al. Optimising the use of cetuximab in the continuum of care for patients with metastatic colorectal cancer. ESMO Open. 2018;3(4):e000353.
[6].Santini D, Vincenzi B, Addeo R, Garufi C, Masi G, Scartozzi M, et al. Cetuximab rechallenge in metastatic colorectal cancer patients: how to come away from acquired resistance? Ann Oncol. 2017;28(11):2906.
[7].Tonini G, Imperatori M, Vincenzi B, Frezza AM, Santini D. Rechallenge therapy and treatment holiday: different strategies in management of metastatic colorectal cancer. Journal of experimental & clinical cancer research. 2013;32(1):92.
[8].Parseghian CM, Loree JM, Morris VK, Liu X, Clifton KK, Napolitano S, et al. AntiEGFR-resistant clones decay exponentially after progression: implications for anti-EGFR rechallenge. Ann Oncol. 2019;30(2):243-9.
[9].Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386-422.
[10].Kaechele V, von Wichert G, Adler G, Seufferlein T. Response to reintroduction of cetuximab in 5 patients with advanced, chemotherapy-resistant, colorectal cancer without progressive disease following first-line therapy with a cetuximab-containing regimen. Oncology. 2008;74(3-4):123-6.
[11].Ho CS, Cheng AC, Li L, Ho WM, Hui EP, To KF, et al. A pilot case-control study of second or third-line treatment with cetuximab-containing chemotherapy (cetux-chemo) in patients (pts) with metastatic colorectal cancer (mCRC) who were previously treated with cetuxchemo. Annals of Oncology. 2018;29.
[12].Cremolini C, Rossini D, Dell'Aquila E, Lonardi S, Conca E, Del Re M, et al. Rechallenge for Patients With RAS and BRAF Wild-Type Metastatic Colorectal Cancer With Acquired Resistance to First-line Cetuximab and Irinotecan: A Phase 2 Single-Arm Clinical Trial. JAMA Oncol. 2019;5(3):343-50.
[13].Nogueira A, Rodrigues J, Jacinto P, Ribeiro J, Bonito N, Marques M, et al. P-167 Cetuximab rechallenge in metastatic colorectal cancer patients. Annals of Oncology. 2016;27.
[14].Ma J, Yang QL, Ling Y. Rechallenge and maintenance therapy using cetuximab and chemotherapy administered to a patient with metastatic colorectal cancer. BMC Cancer. 2017;17(1):132.

Copyright © 2020 Amrou Shaaban, Asit Mohanty, Yousef Abo Eseud, Jasem Albarrak Creative Commons License Publishing time:2020-12-10
This work is licensed under a Creative Commons Attribution 4.0 International License