The Optimal Biological Therapy for Conversion in Patients with RAS-Wild-Type Colorectal Cancer and Unresectable Liver Metastases
9 affiliations
- 1Department of Oncology, Medical Faculty, University of Nis, Dr Zoran Djindjic Boulevard 81, 18108 Nis, Serbia
- 2Clinic of Oncology, University Clinical Centre of Nis, 18000 Nis, Serbia
- 3Department of Surgery, Medical Faculty, University of Nis, 18000 Nis, Serbia
- 4Clinic for Digestive Surgery, University Clinical Centre of Nis, 18000 Nis, Serbia
- 5Department of Internal Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- 6Clinic for Medical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
- 7Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- 8Centre for Medical Oncology, University Clinical Centre of Kragujevac, 34000 Kragujevac, Serbia
- 9Department of Pharmacology and Toxicology, Medical Faculty, University of Nis, 18000 Nis, Serbia
Abstract
Background/Objectives: Resection is the treatment goal in unresectable liver-limited metastatic colorectal cancer (mCRC). Anti-VEGF and anti-EGFR antibodies are effective in RAS wild-type mCRC, but the better option for conversion is unclear. We compared their efficacy and tolerability as first-line treatment. Methods: In this prospective, single-centre cohort study, patients with RAS-wild-type mCRC and unresectable liver metastases received cetuximab or panitumumab (anti-EGFR) or bevacizumab (anti-VEGF) with FOLFOX or FOLFIRI. We compared the overall response rate (ORR), depth of response (DoR), resection rate (RR), progression-free survival (PFS), overall survival (OS) and toxicity, using Cox regression adjusted for baseline covariates. Results: Of 101 patients, 51 received anti-EGFR therapy and 50 bevacizumab. Anti-EGFR therapy achieved a higher ORR (70.6% vs. 50.0%; p = 0.034), deeper response (47.2% vs. 33.7%; p = 0.004) and higher RR (66.7% vs. 46.0%; p = 0.036). The median PFS was longer (12.1 vs. 8.5 months; adjusted HR 0.48, 95% CI 0.29–0.78; p = 0.003), whereas the median OS did not differ significantly (30.4 vs. 25.5 months; p = 0.382). Grade 3/4 toxicity was similar (35.3% vs. 22.0%; p = 0.187). Conclusions: Anti-EGFR therapy was associated with higher response and resection rates and longer PFS and may be considered when conversion is the aim; these single-centre, non-randomised findings require confirmation in randomised studies.
Related
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- A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 2-Advanced Surgical Techniques, Conversion Strategies, and the Expanding Boundaries of Treatment.
- Cohort profile: KaroLiver, a population-based cohort of patients receiving curative liver-directed treatment for colorectal liver metastases at a Swedish tertiary centre
- Sotorasib plus panitumumab and 5-fluorouracil in first-line treatment of patients with unresectable KRAS G12C mutated colorectal cancer unfit for a doublet/triplet chemotherapy: ENGIC 01 – PRODIGE 107 – FFCD 2306 – COLOSOTO trial
- Prognostic Significance of the ESTRO/EORTC Classification of Oligometastatic Disease for Colorectal Cancer Patients With Uncommon Metastases Treated With Definitive Radiotherapy
BibTeX
@article{dzunic2026optimal,
title = {{The Optimal Biological Therapy for Conversion in Patients with RAS-Wild-Type Colorectal Cancer and Unresectable Liver Metastases}},
author = {Miljana Džunić and Ivan Petković and Ana Cvetanović and Miroslav Stojanović and Ivan Nikolić and Marina Marković and Irena Conić and Dane Krtinić},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213489},
url = {https://www.mdpi.com/2072-6694/18/21/3489},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Optimal Biological Therapy for Conversion in Patients with RAS-Wild-Type Colorectal Cancer and Unresectable Liver Metastases
AU - Miljana Džunić
AU - Ivan Petković
AU - Ana Cvetanović
AU - Miroslav Stojanović
AU - Ivan Nikolić
AU - Marina Marković
AU - Irena Conić
AU - Dane Krtinić
PY - 2026
DA - 2026/10/29
JO - Cancers
DO - 10.3390/cancers18213489
UR - https://www.mdpi.com/2072-6694/18/21/3489
AB - Background/Objectives: Resection is the treatment goal in unresectable liver-limited metastatic colorectal cancer (mCRC). Anti-VEGF and anti-EGFR antibodies are effective in RAS wild-type mCRC, but the better option for conversion is unclear. We compared their efficacy and tolerability as first-line treatment. Methods: In this prospective, single-centre cohort study, patients with RAS-wild-type mCRC and unresectable liver metastases received cetuximab or panitumumab (anti-EGFR) or bevacizumab (anti-VEGF) with FOLFOX or FOLFIRI. We compared the overall response rate (ORR), depth of response (DoR), resection rate (RR), progression-free survival (PFS), overall survival (OS) and toxicity, using Cox regression adjusted for baseline covariates. Results: Of 101 patients, 51 received anti-EGFR therapy and 50 bevacizumab. Anti-EGFR therapy achieved a higher ORR (70.6% vs. 50.0%; p = 0.034), deeper response (47.2% vs. 33.7%; p = 0.004) and higher RR (66.7% vs. 46.0%; p = 0.036). The median PFS was longer (12.1 vs. 8.5 months; adjusted HR 0.48, 95% CI 0.29–0.78; p = 0.003), whereas the median OS did not differ significantly (30.4 vs. 25.5 months; p = 0.382). Grade 3/4 toxicity was similar (35.3% vs. 22.0%; p = 0.187). Conclusions: Anti-EGFR therapy was associated with higher response and resection rates and longer PFS and may be considered when conversion is the aim; these single-centre, non-randomised findings require confirmation in randomised studies.
SN - 2072-6694
ER -