{"entity":{"id":"new-epoc","kind":"trial","name":"New EPOC","aka":[],"tldr":"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.","status":"negative","asOf":"2026-09-24","links":[{"label":"New EPOC: systemic chemotherapy with or without cetuximab in resectable colorectal liver metastasis, long-term results (Lancet Oncology 2020)","url":"https://doi.org/10.1016/S1470-2045(19)30798-3"},{"label":"ISRCTN22944367","url":"https://www.isrctn.com/ISRCTN22944367"}],"tags":[],"related":[],"cancers":["colorectal"],"sections":[],"technologies":["monoclonal-antibody","cytotoxic-chemotherapy"],"targets":["egfr","kras"],"drugs":["cetuximab","folfox","capox","oxaliplatin"],"companies":[],"institutions":["birmingham-cancer-centre"],"pathways":[],"terms":["hepatectomy","oligometastatic"],"trials":["eortc-40983"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"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","result":"Median overall survival 55.4 months with cetuximab against 81.0 months without (hazard ratio 1.45).","yearReported":2020,"enrolled":257,"enrolledBasis":"randomised","enrolledNote":"257 eligible patients were randomised; the trial is registered as ISRCTN22944367 and has no NCT number.","outcomes":[{"endpoint":"Overall survival","primary":true,"unit":"months","arms":[{"name":"Chemotherapy plus cetuximab","n":129,"value":55.4},{"name":"Chemotherapy alone","n":128,"value":81}],"hr":1.45,"ci":[1.02,2.05],"p":"0.036","source":"https://doi.org/10.1016/S1470-2045(19)30798-3"},{"endpoint":"Progression-free survival","unit":"months","arms":[{"name":"Chemotherapy plus cetuximab","value":15.5},{"name":"Chemotherapy alone","value":22.2}],"hr":1.17,"ci":[0.87,1.56],"p":"0.304","source":"https://doi.org/10.1016/S1470-2045(19)30798-3"}]},"route":"/trials/new-epoc/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"monoclonal-antibody","kind":"technology","name":"Monoclonal antibodies","route":"/technologies/monoclonal-antibody/"}],"target":[{"id":"egfr","kind":"target","name":"EGFR","route":"/targets/egfr/"},{"id":"kras","kind":"target","name":"KRAS","route":"/targets/kras/"}],"drug":[{"id":"capox","kind":"drug","name":"CAPOX (capecitabine, oxaliplatin)","route":"/drugs/capox/"},{"id":"cetuximab","kind":"drug","name":"Cetuximab","route":"/drugs/cetuximab/"},{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"},{"id":"oxaliplatin","kind":"drug","name":"Oxaliplatin","route":"/drugs/oxaliplatin/"}],"institution":[{"id":"birmingham-cancer-centre","kind":"institution","name":"University Hospitals Birmingham / University of Birmingham Cancer Research Centre","route":"/institutions/birmingham-cancer-centre/"}],"term":[{"id":"colorectal-failed-programmes","kind":"term","name":"Colorectal cancer: the failed and stopped programmes, and why","route":"/terms/colorectal-failed-programmes/"},{"id":"hepatectomy","kind":"term","name":"Hepatectomy (liver resection)","route":"/terms/hepatectomy/"},{"id":"oligometastatic","kind":"term","name":"Oligometastatic disease","route":"/terms/oligometastatic/"}],"trial":[{"id":"eortc-40983","kind":"trial","name":"EORTC 40983","route":"/trials/eortc-40983/"}]}}