# MRC COIN

Source: https://onco.cc/trials/coin/  
OnCo record `coin` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The UK trial that checked whether adding an antibody to first-line chemotherapy for advanced bowel cancer helps people live longer, and found it does not.

## Summary

COIN randomised people with advanced colorectal cancer to oxaliplatin-based chemotherapy with or without cetuximab, having pre-specified that the answer would be read in KRAS wild-type tumours where cetuximab could work. It did not extend overall survival even in that group, although response rates rose. Coming after the enthusiasm generated by CRYSTAL, the result checked the assumption that an anti-EGFR antibody belonged in every first-line regimen and left the NHS position, set by NICE TA439 in 2017, restricted to the RAS wild-type population with FOLFOX or FOLFIRI. Its companion COIN-B tested intermittent chemotherapy with intermittent or continuous cetuximab and supported treatment breaks.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-24
- Also known as: COIN; ISRCTN27286448
- Tags: uk; colorectal; anti-egfr
- Registry id: ISRCTN27286448
- Phase: 3
- Setting: Oxaliplatin-based first-line chemotherapy with or without cetuximab in advanced colorectal cancer, with a third arm of intermittent chemotherapy; the primary comparison was in KRAS wild-type tumours
- Sponsor: Medical Research Council
- Enrolled: 1630
- Result: No overall survival gain from adding cetuximab to oxaliplatin-based first-line chemotherapy, including in KRAS wild-type disease.

## Sources

- Lancet 2011: https://europepmc.org/article/MED/21641636
- ISRCTN27286448: https://www.isrctn.com/ISRCTN27286448

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/)
- targets: [EGFR](https://onco.cc/targets/egfr/), [KRAS](https://onco.cc/targets/kras/)
- drugs: [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/)
- institutions: [Oxford Cancer (Oxford University Hospitals and University of Oxford)](https://onco.cc/institutions/oxford-cancer/), [Velindre Cancer Centre](https://onco.cc/institutions/velindre-cardiff/)
- people: [Tim Maughan](https://onco.cc/people/tim-maughan/)

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JSON: https://onco.cc/api/v1/entities/coin.json