First‐line therapy of bevacizumab plus chemotherapy versus cetuximab plus chemotherapy for metastatic colorectal cancer patients with mucinous adenocarcinoma or mucinous component

Abstract

Background To compare the efficacy of first‐line bevacizumab plus chemotherapy with cetuximab plus chemotherapy based on the stratification of metastatic colorectal cancer (mCRC) patients with mucinous adenocarcinoma (MA) or mucinous component (MC). Methods A retrospective study involving all mCRC patients receiving first‐line bevacizumab‐based or cetuximab‐based chemotherapy at our hospital from September 2013 to January 2020 was conducted. Overall survival (OS), progression‐free survival (PFS), and objective response rate (ORR) were compared between the cetuximab‐chemotherapy group and the bevacizumab‐chemotherapy group on the basis of the conventional pathological classification of MA or MC. Results A total of 620 patients with mCRC were included in our study, consisting of 141 (22.7%) patients with MA/MC and 479 (77.3%) patients with non‐mucinous adenocarcinoma (NMA). In the MA/MC cohort, patients who were treated with bevacizumab‐based chemotherapy were associated with significantly better OS than those treated with cetuximab‐base chemotherapy (30.0 vs. 26.3 months, p = 0.002), irrespective of tumor sites. The efficacy of bevacizumab‐based chemotherapy was higher in nearly all subgroups as shown in the subgroup analysis. In the NMA cohort, median OS was better in the cetuximab plus chemotherapy group than that in the bevacizumab plus chemotherapy group (32.2 vs. 27.0 months, p = 0.005) for left‐side mCRC patients, whereas OS was significantly longer in the bevacizumab plus chemotherapy group for right‐side mCRC patients (26.0 vs. 20.9 months, p = 0.013). Conclusion Conventional pathological classification (e.g. MA/MC) should be considered when tailoring the individualized optimal treatment for mCRC. Bevacizumab plus chemotherapy as first‐line therapy may be the optimal option for patients with MA/MC.

Prognostic significance of mucinous histology in left‑sided metastatic colorectal cancers with wild‑type RAS and evaluation of backbone chemotherapy regimens

“…They found that in only oxa-based CT group, mucinous histology was associated with worse prognosis. Zhou et al ( 18 ) compared CT plus bevacizumab with CT plus cetuximab in the first line setting and also analyzed backbone CT regimens. In patients with mucinous histology, FOLFIRI combined with bevacizumab or cetuximab indicated an improved prognosis than oxa-based regimens.…”

“…Few studies have been conducted on its predictive significance for biological agents. Moretto et al ( 17 ), in the left-sided mCRCs, Zhou et al ( 18 ), regardless of tumor sidedness, emphasized that mucinous histology was a negative predictive factor for anti-EGFR agents. Wang et al ( 19 ) included left-sided RAS/BRAF wild-type mucinous and non-mucinous mCRC patients.…”

“…Nearly all previous studies compared mucinous histology with non-mucinous histology. However, Zhou et al ( 18 ) included mucinous and non-mucinous patients and performed a separate analysis for patients with mucinous histology according to CT regimens. Patients received FOLFIRI or oxa-based CT regimens combined with bevacizumab or cetuximab.…”

The effects of chemotherapy, primary tumor location and histological subtype on the survival of stage III colon cancer patients

“…Chemotherapy resistance usually occurs in RCC [ 17 ]. Accordingly, MAC is always common in RCC and presents a chemoresistance tendency [ 18 , 19 ]. More interestingly, some studies have shown that RCC and MAC have some similar molecular characteristics [ 20 , 21 ].…”

Acute inflammatory reaction during anti-angiogenesis therapy combined with immunotherapy as a possible indicator of the therapeutic effect: Three case reports and literature review

“…Treatments include extensive surgery, radiofrequency ablation, transcatheter arterial chemoembolization, stereotactic body radiation therapy, palliative chemotherapy, targeted therapy, and immunotherapy (2). These new treatments have significantly improved the overall survival (OS) rate of patients with advanced GC or CRC (3)(4)(5)(6)(7). For patients with advanced GI tumors suitable for surgery, resection is still the best way to achieve long-term survival.…”