# New EPOC

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

## TL;DR

Adding the EGFR antibody around liver surgery shortened life by more than two years. It is the clearest warning in bowel cancer that a drug that helps in advanced disease can harm in the curative setting.

## Summary

New EPOC randomised 257 patients with KRAS wild-type (codons 12, 13 and 61) resectable or suboptimally resectable colorectal liver metastases to perioperative oxaliplatin-based chemotherapy with or without cetuximab. At a median 66.7 months, progression-free survival was 22.2 months without cetuximab against 15.5 months with it (hazard ratio 1.17, 95% CI 0.87 to 1.56, p=0.304) and median overall survival 81.0 against 55.4 months (hazard ratio 1.45, 1.02 to 2.05, p=0.036). There was no difference in preoperative response or in resection status. Four of the five possibly treatment-related deaths were in the cetuximab group. The mechanism of the harm has never been explained. New EPOC is why anti-EGFR antibodies are not given around liver resection even in the patients they help most in advanced disease.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-24
- Registry id: ISRCTN22944367
- Phase: 3
- Setting: KRAS wild-type resectable or suboptimally resectable colorectal liver metastases: perioperative chemotherapy with or without cetuximab
- Sponsor: University of Birmingham / Cancer Research UK
- Enrolled: 257
- Result: Median overall survival 55.4 months with cetuximab against 81.0 months without (hazard ratio 1.45).
- Outcomes: Overall survival: Chemotherapy plus cetuximab 55.4 months vs Chemotherapy alone 81 months, HR 1.45; Progression-free survival: Chemotherapy plus cetuximab 15.5 months vs Chemotherapy alone 22.2 months, HR 1.17

## Sources

- New EPOC: systemic chemotherapy with or without cetuximab in resectable colorectal liver metastasis, long-term results (Lancet Oncology 2020): https://doi.org/10.1016/S1470-2045(19)30798-3
- ISRCTN22944367: https://www.isrctn.com/ISRCTN22944367

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/)
- 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: [University Hospitals Birmingham / University of Birmingham Cancer Research Centre](https://onco.cc/institutions/birmingham-cancer-centre/)
- terms: [Colorectal cancer: the failed and stopped programmes, and why](https://onco.cc/terms/colorectal-failed-programmes/), [Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/)
- trials: [EORTC 40983](https://onco.cc/trials/eortc-40983/)

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