title: Cetuximab after bevacizumab in metastatic colorectal cancer: is it the best sequence?
abstract: BACKGROUND
  Chemotherapy combinations and addition of cetuximab or bevacizumab to chemotherapy have been shown to improve overall survival of metastatic colorectal cancer (CRC) patients. However, the efficacy of cetuximab when administered after bevacizumab failure is still unknown.
  
  
  METHODS
  Fifty-eight consecutive patients diagnosed with advanced colorectal cancer between treated with cetuximab following irinotecan failure were included in our analysis. A multivariate Cox model analysis was performed to estimate the effect of previous bevacizumab regimen on survival.
  
  
  RESULTS
  Thirteen (22.4%) were pre-treated with anti-VEGF agents. None of them responded to cetuximab, and this subgroup presented a significantly decreased disease-specific survival as compared to treatment-naïve patients (9.1 months vs. 4.9 months; p=0.026). This difference remained statistically significant in a multivariate Cox model after adjusting for age, sex, performance status (PS), and K-RAS status (RR=2.2; 95% CI: 1.1-4.5, p=0.03).
  
  
  CONCLUSIONS
  These study results suggest that a previous anti-VEGF therapy decrease cetuximab efficiency.
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Service d'Oncologie Digestive Hôpital Timone, Université de la Méditerranée, Marseille, France. emmanuelle.norguet@ap-hm.fr
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Norguet
authors.forename: Laetitia
authors.initials: L
authors.lastname: Dahan
authors.forename: Jean
authors.initials: J
authors.lastname: Gaudart
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gasmi
authors.forename: L'houcine
authors.initials: L
authors.lastname: Ouafik
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Seitz
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D018572:Disease-Free Survival; D011905:Genes, ras; D006801:Humans; D000077146:Irinotecan; D053208:Kaplan-Meier Estimate; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011725:Pyridines / Q000008:administration & dosage; D017211:Treatment Failure; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D011725:Pyridines; D042461:Vascular Endothelial Growth Factor A; C431073:oxiplatin; D000068258:Bevacizumab; D000077146:Irinotecan; D000068818:Cetuximab; D002166:Camptothecin