Cetuximab plus irinotecan versus panitumumab in patients with refractory metastatic colorectal cancer in Ontario, Canada

The addition of irinotecan to an epidermal growth factor receptor (EGFR) antibody has previously been shown to improve tumor response rate and time to progression but not overall survival (OS) for refractory metastatic colorectal cancer (mCRC). We assessed the “real‐world” effectiveness and toxicity...

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Bibliographic Details
Published in:International journal of cancer 2017-05, Vol.140 (9), p.2162-2167
Main Authors: Jerzak, Katarzyna J., Berry, Scott, Ko, Yoo‐Joung, Earle, Craig, Chan, Kelvin K. W.
Format: Article
Language:English
Subjects:
Aged
Antibodies, Monoclonal - administration & dosage
Antibodies, Monoclonal, Humanized - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Camptothecin - administration & dosage
Camptothecin - analogs & derivatives
Canada
Cancer
Cetuximab - administration & dosage
Colorectal cancer
Colorectal Neoplasms - drug therapy
Colorectal Neoplasms - genetics
Colorectal Neoplasms - pathology
comparative effectiveness
Disease-Free Survival
EGFR antibody
elderly
Epidermal growth factor
Exons
Female
Health risk assessment
Humans
Male
Medical research
Metastasis
Middle Aged
Neoplasm Metastasis
Proto-Oncogene Proteins p21(ras) - genetics
Receptor, Epidermal Growth Factor - antagonists & inhibitors
Receptor, Epidermal Growth Factor - genetics
Treatment Outcome
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Summary:The addition of irinotecan to an epidermal growth factor receptor (EGFR) antibody has previously been shown to improve tumor response rate and time to progression but not overall survival (OS) for refractory metastatic colorectal cancer (mCRC). We assessed the “real‐world” effectiveness and toxicity of the combination versus monotherapy. In Ontario, Canada, universal public funding is available for either cetuximab plus irinotecan (Cmab + I) combination therapy or panitumumab (Pmab) monotherapy, only in patients with refractory nonmutated RAS mCRC. All patients diagnosed before December 2012 and treated with an EGFR antibody for mCRC were identified from the Ontario drug database and linked to the Ontario Cancer Registry and other administrative databases to ascertain baseline characteristics, health services utilization, and outcomes. Multivariable Cox and logistic models were constructed to compare the time to treatment discontinuation (TTD), OS, emergency department (ED) or hospital visits between Cmab + I and Pmab. Observable confounders were adjusted for using propensity score methods. One thousand and eighty‐one patients were identified (Cmab + I: 278, Pmab: 803). Patients receiving Cmab + I were younger (mean age 61 vs 64 years) and had a longer duration of prior irinotecan treatment. The use of Cmab + I as compared to Pmab alone was associated with a prolonged TTD [median: 3.8 months vs 2.8 months] and an improved OS [median: 8.8 months vs. 5.9 months] with an adjusted HR of 0.62 [95% CI 0.53–0.73, p 
ISSN:0020-7136
1097-0215
DOI:10.1002/ijc.30637