FIRE-3 and C80405: Is There a Best Choice for Initial Treatment of Metastatic Colorectal Cancer?

Abstract

In the treatment of metastatic colorectal cancer, chemotherapy is used as a backbone to which an angiogenesis inhibitor such as bevacizumab (vascular endothelial growth factor [VEGF]) or a monoclonal antibody to the epidermal growth factor receptor (EGFR) such as cetuximab or panitumumab is added. In this article, we seek answers to the question: “FIRE-3 and C80405: is there a best choice for initial treatment of metastatic colorectal cancer?” In the absence of clear and univocal evidence that EGFR inhibitors should be used in the first-line setting for patients with metastatic RAS wild-type colorectal cancer, the physician and patient still have the choice between bevacizumab or an EGFR inhibitor as addition to the chemotherapy (FOLFIRI or FOLFOX) in this setting. This choice will be influenced by the different toxicity profiles of bevacizumab and cetuximab or panitumumab and will therefore depend on existing comorbidities of the patient and patient/physician preferences. The higher response rate of the combination of chemotherapy with cetuximab could make this treatment more interesting as induction therapy.