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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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
257 randomised.
Shares Colorectal cancer: the failed and stopped programmes, and why, Oxaliplatin, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares Colorectal cancer: the failed and stopped programmes, and why, Oxaliplatin, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares EORTC 40983, Hepatectomy (liver resection), Oligometastatic disease, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares CAPOX (capecitabine, oxaliplatin), Oxaliplatin, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares Hepatectomy (liver resection), Oligometastatic disease, Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin).
Shares Oxaliplatin, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), EGFR.
Shares Oxaliplatin, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), EGFR.
Shares Colorectal cancer: the failed and stopped programmes, and why, CAPOX (capecitabine, oxaliplatin), Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin).