A Phase II Study of Sorafenib Combined With Cetuximab in EGFR-Expressing, KRAS-Mutated Metastatic Colorectal Cancer.

Abstract

BACKGROUND:

Mutations in the KRAS gene predict for resistance to anti-epidermal growth factor receptor (EGFR) therapies, including cetuximab. Upregulation of vascular endothelial growth factor (VEGF)-A has been implicated in resistance to anti-EGFR treatment. Abrogation of the VEGF and RAS/RAF/MEK/ERK pathways has the potential to restore cetuximab sensitivity.

PATIENTS AND METHODS:

Adult patients with histologically documented, measurable, EGFR-expressing, KRAS-mutated metastatic colorectal cancer (mCRC) that had progressed after 5-fluorouracil-based regimens were treated with sorafenib 400 mg orally twice daily and intravenous cetuximab weekly in 28-day cycles. The primary endpoint was the response rate (complete response, partial response, and stable disease at 4 cycles). The secondary endpoints included plasma biomarker analysis of angiogenic cytokines and correlative imaging studies with dynamic contrast-enhanced magnetic resonance imaging and zirconium 89-panitumumab.

RESULTS:

Of the 30 patients enrolled, 26 were evaluable for response. Of the 26 patients evaluated, 4 had stable disease at 4 cycles and 1 had stable disease at 8 cycles. The median progression-free survival was 1.84 months. The common toxicities were rash, diarrhea, and liver enzyme elevations. Of the angiogenic cytokines evaluated, only the placental growth factor increased significantly with treatment (P < .0001). No pharmacodynamic parameters were associated with the treatment response.

CONCLUSION:

We report the results of a trial that combined cetuximab and sorafenib for the treatment of KRAS-mutated mCRC, with correlative imaging studies and pharmacodynamic angiogenic cytokine profiling as downstream markers of EGFR and VEGF receptor (VEGFR) signaling. No objective responses were observed. Additional development of biomarkers for patient selection is needed to evaluate combined EGFR and VEGFR blockade as a therapeutic option in KRAS-mutated CRC.

• Authors: Khanh Do, Liang Cao, Zhigang Kang, Baris Turkbey, Maria L Lindenberg, Erin Larkins, Beata Holkova, Seth M Steinberg, Mark Raffeld, Cody J Peer, William D Figg, Michelle Eugeni, Paula Jacobs, Peter Choyke, John J Wright, James H Doroshow, Shivaani Kummar
• Journal: Clinical colorectal cancer (Clin Colorectal Cancer) Vol. 14 Issue 3 Pg. 154-61 (Sep 2015) ISSN: 1938-0674 [Electronic] United States
• PMID: 25861837 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Inc.

Chemical References

• KRAS protein, human
• Phenylurea Compounds
• Vascular Endothelial Growth Factor A
• Niacinamide
• Sorafenib
• ErbB Receptors
• Proto-Oncogene Proteins p21(ras)
• Cetuximab

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (pharmacology, therapeutic use)
• Cetuximab (administration & dosage)
• Colorectal Neoplasms (drug therapy, genetics, pathology)
• Disease-Free Survival
• ErbB Receptors (antagonists & inhibitors)
• Female
• Humans
• Male
• Middle Aged
• Niacinamide (administration & dosage, analogs & derivatives)
• Patient Selection
• Phenylurea Compounds (administration & dosage)
• Proto-Oncogene Proteins p21(ras) (genetics)
• Sorafenib
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Young Adult