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Optimizing sequential treatment with anti-EGFR and VEGF mAb in metastatic colorectal cancer: current results and controversies

Authors Chen DT, Gu KK, Wang HY

Received 27 November 2018

Accepted for publication 21 January 2019

Published 19 February 2019 Volume 2019:11 Pages 1705—1716


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Chien-Feng Li

Datian Chen,1 Kaikai Gu,2 Huiyu Wang3

1Department of Oncology, Haimen People’s Hospital, Haimen, People’s Republic of China; 2Haimen Hospital of Traditional Chinese Medicine, Haimen, People’s Republic of China; 3Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, People’s Republic of China

Abstract: Anti-EGFR mAb (cetuximab or panitumumab) and anti-VEGF mAb (bevacizumab) are the two main targeted agents available for RAS wild-type (WT) metastatic colorectal cancer (mCRC) treatment. Nonetheless, three head-to-head clinical trials evaluating anti-EGFR mAb vs -VEGF mAb in first-line treatment failed to conclude a uniform result. Recently, a few small clinical studies revealed that prior use of bevacizumab may impair the effect of cetuximab or panitumumab. Preclinical studies have also suggested that pretreatment with bevacizumab may lead to simultaneous resistance to anti-EGFR mAb. Therefore, we performed this review to summarize the available data regarding the optimal sequential treatment of anti-EGFR and -VEGF mAb for RAS or KRAS WT mCRC and discuss the potential mechanisms that may explain this phenomenon. Primary tumor location and early tumor shrinkage have emerged as new potential prognostic and predictive factors in mCRC. We also collected information to explore whether these factors affect the optimal sequencing of targeted therapy in mCRC. However, definite conclusions cannot be made, and we can only speculate on optimal treatment recommendations based on the contradictory results.

Keywords: anti-EGFR mAb, bevacizumab, treatment sequence, metastatic colorectal cancer

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