The Role of Targeted Therapy in Adjuvant Colorectal Cancer Trials: Where Did We Go Wrong and Where Do We Go from Here?

摘要

The new biologic drugs active in the advanced setting of colorectal cancer have failed when used in the adjuvant setting. Both bevacizumab (BEVA) and cetuximab (CET) added to oxaliplatin-based chemotherapy (CT) have produced no improvements in 3-year disease-free survival (DFS) rates compared with CT alone. Even worse, the possibility exists that both agents are actually detrimental to the efficacy of CT in this setting. BEVA, after an initial impressive delay in relapses (0.6 hazard ratio [HR] for DFS at 12 months in both the NSABP C-08 and AVANT studies) did not maintain this beneficial effect; more relapses and deaths occurred, compared with CT alone in the 2 years after discontinuation of the antiangiogenic agent. The danger of a rebound effect is real.