AROME-ESO Oncology Consensus Conference: access to cancer care innovations in countries with limited resources. Association of Radiotherapy and Oncology of the Mediterranean Area (AROME-Paris) and European School of Oncology (ESO - Milan).

PURPOSE: Cancer is a leading cause of mortality worldwide. Its incidence is still increasing, particularly in developing countries. Recent progresses further strengthen the differences between low/middle and high-income countries. This situation calls for joint action to reduce inequities in cancer outcomes among the patients. The Association of Radiotherapy and Oncology of the Mediterranean Area (AROME) and the European School of Oncology (ESO), have initiated joint conferences devoted to access to innovations in oncology in the Mediterranean area. The heterogeneity of the economic, political and cultural situations of the different participating countries, offers the opportunity to develop consensus conference. METHODS: Cancer prevention and treatment strategies were discussed according to existing international guidelines. The Scientific committee prepared 111 questions with an objective to prioritize the access to treatments and innovations in low/middle-income Mediterranean countries. The results from the votes of 65 oncology experts, coming from 16 countries and 33 institutions have been analysed and access priorities classified accordingly. RESULTS: Ninety six percent of the proposed general recommendations concerning national health care strategies, oncology education, and treatment organization were considered to be high priorities. Regarding access to systemic treatments, 41% of the drugs without validated predictive markers and 53% of those with validated predictive markers were considered to be 1st level priority. Only 4 biological tests were considered to be 1st level priority to access to innovation. CONCLUSIONS: AROME-ESO consensus offers to cancer specialists from developing countries a basis for discussion with health authorities and payers on the prioritization of access to innovations in cancer care.

Cetuximab in third-line therapy of patients with metastatic colorectal cancer: A single institution experience.

PURPOSE: Cetuximab, an IgG1 chimeric monoclonal antibody (MAB) against epidermal growth factor receptor (EGFR) has activity against metastatic colorectal cancers (mCRC) that express EGFR. The purpose of this study was to demonstrate the efficacy and safety of cetuximab administered to patients with EGFR-positive mCRC. METHODS: 72 patients with wild-type KRAS mCRC were enrolled. All of them had previously been treated with a fluoropyrimidine, oxaliplatin and irinotecan-based chemotherapy. Patients received cetuximab as monotherapy or in combination with irinotecan-based chemotherapy. All patients were to be treated until the occurrence of disease progression or unacceptable toxicity. RESULTS: All patients were evaluated for progression free survival (PFS), overall survival (OS) and safety. The median PFS was 4.77 months (95% CI: 4.08-5.45), with an actuarial 47.22% without progression at 3 months and 16.67% at 6 months. The median OS was 11.35 months (95% CI: 9.64-13.06), with 79.17% of the patients being alive at 6 months and 30.56% at 12 months. PFS was significantly higher in patients with skin toxicity as compared to those without skin toxicity (5.31 vs 2.61 months, p<0.001) and with smaller number of metastatic organs vs greater number of metastatic organs (p=0.05). OS was significantly higher in patients with good performance status (p=0.004), with skin toxicity (p=0.013) and with smaller number of metastatic organs (p<0.001). Superior survival rates with higher grades of skin toxicity were noticed. As for patient characteristics, there were no significant differences in age, gender, and primary site localization. CONCLUSION: Cetuximab improved PFS, OS and preserved the quality of life in patients with mCRC whose previous treatments had failed.