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COIN: Cetuximab added no benefit in colorectal cancer, but treatment breaks may help some
The addition of cetuximab to first-line combination chemotherapy did not add any benefit in OS or PFS in patients with advanced colorectal cancer, including patients with wild-type KRAS mutations, according to results from the Medical Research Council COIN trial. However, a companion paper showed that patients with normal platelet counts saw improved quality of life when given time off of chemotherapy.
The randomized controlled COIN trial enrolled chemotherapy-naive patients with advanced colorectal cancer and randomly assigned them to oxaliplatin and fluoropyrimidine (arm A; n=815); this combination plus cetuximab (Erbitux, ImClone; arm B; n=815); or intermittent chemotherapy (arm C; n=815). In arm C, patients with no progression at 12 weeks started a chemotherapy-free period until signs of disease progression.
In the comparison of arms A and B, researchers looked at the patients with KRAS wild-type tumors and found that there was no difference in OS (17.9 months in arm A vs. 17 months in arm B) or PFS (8.6 months vs. 8.6 months).
In the comparison of arms A and C, researchers found that intermittent chemotherapy did not increase or decrease survival. However, results indicated that about 25% of patients had a raised platelet count, which predicted inferior survival and decreased quality of life when assigned intermittent therapy.
“By contrast, the three-quarters of patients with normal platelet counts had improved quality of life on almost all measures, with no detriment in OS,” the researchers wrote.
For more information:
- Adams RA. Lancet. 2011:doi:10.1016/S1470-2045(11)70102-4.
- Maughan TS. Lancet. 2011;doi:10.1016/S0140-6736(11)60788-5.