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Cetuximab,  a monoclonal antibody targeting epidermal growth factor receptor, has proven to  be efficient in the treatment of metastatic colorectal cancer. We made a  prospective study of the efficacy and toxicities of cetuximab-combination  first-line (FOLFOX4) versus second/third-line (FOLFIRI) chemotherapy in 98 KRAS wild-type patients who had metastatic colorectal cancer. Wild-type KRAS had  been identified by direct sequencing. Associations between clinical  response/progression-free survival/overall survival/toxicities and cetuximab-combination  chemotherapy timing were evaluated. The overall response rate was  significantly higher for first-line treatment than for second/third-line  treatment (relative risk = 1.707, 95% confidence interval = 1.121-2.598). Both  progression-free survival and overall survival indicated significantly longer  survival of first-line treatment than second/third-line treatment patients.  This study is a validation of a molecular analysis of KRAS wild-type  status for the prediction of response to cetuximab-combination chemotherapy for  metastatic colorectal cancer patients; its predictive role was less prominent  in the second/third-line than in the first-line treatment patients.

Prospective analysis of KRAS wild-type patients with metastatic colorectal cancer using cetuximab plus FOLFIRI or FOLFOX4 treatment regimens