# Anti-EGFR antibody + chemotherapy in left-sided RAS/BRAF wild-type mCRC

Source: https://onco.cc/pairings/anti-egfr-left-sided/  
OnCo record `anti-egfr-left-sided` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In bowel cancers that start on the left and have normal RAS and BRAF genes, adding an EGFR antibody to chemotherapy gives the longest survival seen in first-line trials.

## Summary

PARADIGM: OS 37.9 months with panitumumab + mFOLFOX6 in left-sided RAS wild-type disease. FIRE-3 and CALGB 80405 subgroups agree. Right-sided or RAS/BRAF-mutant tumours should get bevacizumab instead. Anti-EGFR rechallenge after a chemotherapy-free interval, guided by ctDNA showing RAS/EGFR clones have receded (CHRONOS), is an emerging strategy.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Panitumumab + FOLFOX (5-FU, leucovorin, oxaliplatin)
- Type: combination
- Rationale: Left-sided tumours are EGFR-ligand dependent and RAS wild-type; right-sided tumours carry BRAF, dMMR, and other resistance biology.
- Evidence: Phase 3 (PARADIGM) with OS benefit; multiple consistent retrospective analyses.

## Sources

- ClinicalTrials.gov NCT02394795: PARADIGM: https://clinicaltrials.gov/study/NCT02394795

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- drugs: [Cetuximab](https://onco.cc/drugs/cetuximab/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Panitumumab](https://onco.cc/drugs/panitumumab/)
- terms: [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/)
- trials: [CRYSTAL & FIRE-3](https://onco.cc/trials/crystal-fire3/), [PARADIGM](https://onco.cc/trials/paradigm/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)

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