【Literature Recommended Reading】Column Introduction
I didn't realize the pond spring grass dream, and the leaves of the sycamore in front of the steps were already autumn. In this issue, Professor Yuan Ying, Director of the Department of Oncology and Doctor of Oncology of the Second Affiliated Hospital of Zhejiang University School of Medicine, made a literature recommendation in the field of bowel cancer. Let's follow her thoughts and explore the road of medical literature together!
Bowel Cancer Editor-in-Chief recommends:
Panizumab plus fluorouracil and calcium folinate vernacular in the maintenance treatment of RAS wild-type metastatic colorectal cancer: a randomized PANAMA study (AIO KRK 0212)
Introduction to bowel cancer editor-in-chief
Professor Yuan Ying
Director of the Department of Internal Medicine, Doctor of Oncology, Chief Physician and Doctoral Supervisor of the Second Affiliated Hospital of Zhejiang University School of Medicine
Deputy Director of the Key Laboratory of Early Warning and Intervention of Malignant Tumors of the Ministry of Education
Executive Deputy Editor-in-Chief and Director of the Editorial Department of the Journal of Practical Oncology
Member of the Standing Committee of the Colorectal Cancer Professional Committee of the Chinese Anti-Cancer Association and the leader of the Genetics Group
Member of the Tumor Targeted Therapy Professional Committee of the Chinese Anti-Cancer Association
Member of the Metastasis Professional Committee of the Chinese Anti-Cancer Association
Director of the Chinese Association of Clinical Oncology (CSCO).
Translator Profile
Chen Jiaqi
Department of Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine
Doctor of Medicine (M.D.), Deputy Chief Physician
Graduated from Peking Union Medical College for eight years
Youth Member of Integrated Oncology Branch of Chinese Anti-Cancer Association
Secretary of the Colorectal Cancer Youth Committee of Zhejiang Anti-Cancer Association
Youth Member of national health literacy promotion branch of China Medical and Health Culture Association
The text is as follows
background
The PANAMA study analyzed whether the addition of panizumab to maintenance therapy with fluorouracil and calcium folinate in patients with RAS wild-type advanced colorectal cancer could provide further benefits.
method
After induction therapy with first-line 6 cycles of oxaliplatin, fluorouracil and calcium folinate combined with panizumab, patients with effective treatment (SD or PR or CR) were randomly assigned 1:1 open to the fluorouracil and calcium folinate combined with panitumab maintenance therapy group or to the maintenance therapy group with fluorouracil and calcium folinate alone. The study was a efficacy study, the main endpoint was PFS, the set target hazard ratio (HR) was 0.75, and the significance difference in weight was 10%. Secondary study endpoints included OS, ORR during maintenance therapy, and toxicity. Survival outcome analysis was performed using the KM method and verified using log-rank test compared with Cox regression. Use Fisher's exact test for binary variables to compare and, where applicable, use odds ratio validation. Clinical study registered in ClinicalTrials.gov (NCT01991873).
outcome
Eventually, 248 patients were randomized and received maintenance therapy, of which 125 patients received maintenance therapy with fluorouracil and calcium folinate in combination with panitumab, while 123 patients received fluorouracil and calcium folinate. After 218 events, the study concluded that increasing patenizumab maintenance therapy was effective in improving PFS (8.8 months versus 5.7 months; HR, 0.72; 80% CI, 0.60 to 0.85; P =0.014）。 In the overall survival (event incidence: 54%), the increase in panitumab was data superior to the fluorouracil plus calcium folinic acid group alone (28.7 months v 25.7 months; HR, 0.84; 95% CI, 0.60 to 1.18; P =0.32）。 ORR increased penitizumab to 40.8%, compared with 26.0% for fluorouracil and calcium folinic acid alone (odds ratio, 1.96; 95% CI,1.14 to 3.36; P=0.02）。 After the increase of panitumab, the most common adverse reaction of grade 3 or above was a rash (7.2%).
Figure 1: The addition of panizumab to maintenance therapy improves PFS and OS after induction chemotherapy (data are superior, not statistically different)
Figure 2: Subgroup analyses all suggest that the addition of panitumab is preferred
illustrate
In patients with RAS wild-type advanced colorectal cancer, the addition of panizumab to treatment with fluorouracil and calcium loofrite can effectively improve PFS. Fluorouracil and calcium folinate plus panitumab maintenance therapy are the most advantageous options for patients who are effective in inducing treatment with oxaliplatin, fluorouracil and calcium folinic acid combined with panitumab.
Editor-in-chief comments
The preliminary results of the PANAMA study have been disclosed at several major international conferences on oncology, and the final results were published this year. The results confirm the feasibility of maintenance therapy with anti-EGFR-targeted drugs, and the way parnizumab combined with fluorouracil and leucovorin is an effective option. The findings will change the pattern of maintenance therapy for advanced colorectal cancer, adding anti-EGFR-targeted drugs as a new modality of maintenance therapy. Domestically, since panizumab is not marketed, the treatment model of cetuximab combined with fluorouracil and calcium folinate may also be one of the options, but it also requires further validation of similar large clinical studies.
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