FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, irinotecan) plus panitumumab is a feasible treatment strategy for patients with metastatic KRAS wild-type colorectal cancer with liver-only metastases, according to a study published in the journal The Oncologist.1

Because patients with liver-only metastatic colorectal cancer (mCRC) who are not eligible to undergo curative resection may become resectable following aggressive chemotherapy, researchers sought to evaluate FOLFOXIRI plus panitumumab as frontline treatment in this setting.

For the phase 2 study, patients received fluorouracil 3200 mg/m2 as a 48-hour continuous IV infusion, leucovorin 200 mg/m2 IV, irinotecan 125 mg/m2 IV, oxaliplatin 85 mg/m2 IV, and panitumumab 6 mg/kg IV on day 1 of each 14-day cycle. Two-thirds of patients were surgical candidates at baseline and all KRAS mutations were on exon 2.

Results showed that 60% of patients achieved a partial response, and of the 67% of patients who underwent surgery, all had complete resections and pathologic partial response.

In terms of safety, 33% and 20% of patients experienced grade 3 diarrhea and rash, respectively.

However, the study was stopped early due to emerging data that patients with exon 2 KRAS/NRAS mutations may have negative clinical outcomes with oxaliplatin-based therapy.

“This regimen remains a viable option for patients with liver-only mCRC in the KRAS/NRAS wild-type population,” the authors conclude. “Enrollment criteria on future studies should include testing for the newly identified mutations.”

REFERENCE

1. Bendell JC, Zakari A, Peyton JD, et al. A phase II study of FOLFOXIRI plus panitumumab followed by evaluation for resection in patients with metastatic. KRAS wild-type colorectal cancer with liver metastases only [published online ahead of print February 24, 2016]. Oncologist. doi:10.1634/theoncologist.2015-0439.