Erbitux and Avastin combination in colon cancer – pro

The strategy of combining Avastin and Erbitux is supported by the results of the BOND-2 trial presented at the ASCO Gastrointestinal Cancers Symposium. The trial’s predecessor, BOND-1, was a randomized phase 2 trial conducted in patients with advanced CRC who had failed irinotecan-based therapy, more than 60% of whom also received oxaliplatin-based therapy. Patients were randomized to receive either cetuximab or cetuximab plus rinotecan as salvage therapy. The results of BOND-1 firmly established the efficacy of cetuximab in advanced CRC, leading to the FDA approval of cetuximab in February 2004. BOND-2 investigated the effect of the addition of bevacizumab to the BOND-1 design. Patients with advanced CRC who had all failed irinotecan-based therapy, more than 80% of whom had also been pretreated with oxaliplatin, were enrolled in a randomized phase 2 trial comparing cetuximab plus bevacizumab (CB) vs cetuximab/bevacizumab plus irinotecan (CBI) as salvage therapy. While survival is not yet different, responses and time to failure were much better on the Avastin/Erbitux arm. These results are still preliminary and the full trial has not been completed and published and it needs to be subjected to peer review and discussion before being adopted. This regimen is not NCCN recommended. Of concern, a similar trial reported in 2009, with panitumumab instead of cetuximab, showed that he addition of panitumumab to bevacizumab and oxaliplatin- or irinotecan-based chemotherapy results in increased toxicity and decreased PFS. These combinations are not recommended for the treatment of mCRC in clinical practice.

Saltz L, Lenz H, Kindler HL, et al. Interim report of randomized phase II trial of cetuximab/bevacizumab/irinotecan (CBI) versus cetuximab/bevacizumab (CB) in irinotecan-refractory colorectal cancer. Program and abstracts of the American Society of Clinical Oncology 2005 Gastrointestinal Cancers Symposium; January 27-29, 2005; Hollywood, Florida. Abstract 169b., colon cancer

Kohne, Claus-Henning , Lenz, Heinz-Josef
Chemotherapy with Targeted Agents for the Treatment of Metastatic Colorectal Cancer
Oncologist 2009 14: 478-488; doi:10.1634/theoncologist.2008-0202

Hecht, J. Randolph, Mitchell, Edith, Chidiac, Tarek, Scroggin, Carroll, Hagenstad, Christopher, Spigel, David, Marshall, John, Cohn, Allen, McCollum, David, Stella, Philip, Deeter, Robert, Shahin, Seta, Amado, Rafael G.
A Randomized Phase IIIB Trial of Chemotherapy, Bevacizumab, and Panitumumab Compared With Chemotherapy and Bevacizumab Alone for Metastatic Colorectal Cancer
J Clin Oncol 2009 27: 672-680

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