Biomarker-stratified first-line treatment of right-sided metastatic colon cancer with interdisciplinary collaboration in the IVOPAK II trial.

ABSTRACT

Patients with right-sided metastatic colon carcinoma have a significantly worse prognosis than those with left-sided colorectal cancer (CRC), regardless of treatment. The aim of the prospective IVOPAK II study was to implement an interdisciplinary guideline-conform personalized CRC palliative therapy of metastatic colorectal carcinoma and to improve the overall survival (OS) by multidisciplinary approach via secondary metastatic resection. We present the efficacy data of first-line treatment and the benefit of interdisciplinary collaboration of right-sided metastatic colon carcinoma patients n = 25. RAS mutation n = 20 (80%) received systemic first-line treatment FOLFIRI plus bevacizumab. All-RAS-wildtype n = 5 (20%) received systemic first-line treatment FOLFIRI plus cetuximab. Last date evaluation 31 January 2024. Median age 59.6 years (range 42-71), men/women 14/11. Eastern Cooperative Oncology Group (ECOG) index 0/1/2  11/10/4. Evaluable for response n = 25. Complete response n = 0, partial response n = 14 (56%), stable disease n = 8 (32%), progressive disease n = 3 (12%), early tumor shrinkage n = 13 (52%), estimates progression-free survival 13 months (95% CI 8-17 months), estimated OS 48 months (95% CI 25-71 months), median follow-up 26 months (1-61 months), no evidence of disease n = 4 (16%). A chemotherapy doublette regimen with FOLFIRI plus a biological as first-line treatment shows promising efficacy and secondary metastatic resection after interdisciplinary discussion was associated with a survival benefit in right-sided metastatic colon carcinoma.