Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Oncology, FOLFIRI PLUS BEVACIZUMAB, 1ST-LINE TREATMENT, OPEN-LABEL, STATISTICS, CLASSIFICATION, CHEMOTHERAPY, INHIBITION, CETUXIMAB, FIRE-3, MODELS, Aged, Antineoplastic Combined Chemotherapy Protocols, Bevacizumab, Cetuximab, Colorectal Neoplasms, Disease-Free Survival, Female, Fluorouracil, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Humans, Irinotecan, Kaplan-Meier Estimate, Leucovorin, Male, Middle Aged, Neoplasm Metastasis, Oxaliplatin, Predictive Value of Tests, Prognosis, Treatment Outcome, 1103 Clinical Sciences, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, 3211 Oncology and carcinogenesis

Abstract:

PURPOSE: To determine the predictive and prognostic value of the consensus molecular subtypes (CMSs) of colorectal cancer (CRC) that represent a merging of gene expression-based features largely in primary tumors from six independent classification systems and provide a framework for capturing the intrinsic heterogeneity of CRC in patients enrolled in CALGB/SWOG 80405. PATIENTS AND METHODS: CALGB/SWOG 80405 is a phase III trial that compared the addition of bevacizumab or cetuximab to infusional fluorouracil, leucovorin, and oxaliplatin or fluorouracil, leucovorin, and irinotecan as first-line treatment of advanced CRC. We characterized the CMS classification using a novel NanoString gene expression panel on primary CRCs from 581 patients enrolled in this study to assess the prognostic and predictive value of CMSs in these patients. RESULTS: The CMSs are highly prognostic for overall survival (OS; P < .001) and progression-free survival (PFS; P < .001). Furthermore, CMSs were predictive for both OS (P for interaction < .001) and PFS (P for interaction = .0032). In the CMS1 cohort, patients treated with bevacizumab had a significantly longer OS than those treated with cetuximab (P < .001). In the CMS2 cohort, patients treated with cetuximab had a significantly longer OS than patients treated with bevacizumab (P = .0046). CONCLUSION: These findings highlight the possible clinical utility of CMSs and suggests that refinement of the CMS classification may provide a path toward identifying patients with metastatic CRC who are most likely to benefit from specific targeted therapy as part of the initial treatment.