A Phase II Study of Sorafenib Combined With Cetuximab in EGFR-Expressing, KRAS-Mutated Metastatic Colorectal Cancer

Khanh Do, Liang Cao, Zhigang Kang, Baris Turkbey, Maria L. Lindenberg, Erin Larkins, Beata Holkova, Seth M. Steinberg, Mark Raffeld, Cody J. Peer, William D. Figg, Michelle Eugeni, Paula Jacobs, Peter Choyke, John J. Wright, James H. Doroshow, Shivaani Kummar

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background Mutations in the KRAS gene predict for resistance to anti-epidermal growth factor receptor (EGFR) therapies, including cetuximab. Upregulation of vascular endothelial growth factor (VEGF)-A has been implicated in resistance to anti-EGFR treatment. Abrogation of the VEGF and RAS/RAF/MEK/ERK pathways has the potential to restore cetuximab sensitivity. Patients and Methods Adult patients with histologically documented, measurable, EGFR-expressing, KRAS-mutated metastatic colorectal cancer (mCRC) that had progressed after 5-fluorouracil-based regimens were treated with sorafenib 400 mg orally twice daily and intravenous cetuximab weekly in 28-day cycles. The primary endpoint was the response rate (complete response, partial response, and stable disease at 4 cycles). The secondary endpoints included plasma biomarker analysis of angiogenic cytokines and correlative imaging studies with dynamic contrast-enhanced magnetic resonance imaging and zirconium 89-panitumumab. Results Of the 30 patients enrolled, 26 were evaluable for response. Of the 26 patients evaluated, 4 had stable disease at 4 cycles and 1 had stable disease at 8 cycles. The median progression-free survival was 1.84 months. The common toxicities were rash, diarrhea, and liver enzyme elevations. Of the angiogenic cytokines evaluated, only the placental growth factor increased significantly with treatment (P <.0001). No pharmacodynamic parameters were associated with the treatment response. Conclusion We report the results of a trial that combined cetuximab and sorafenib for the treatment of KRAS-mutated mCRC, with correlative imaging studies and pharmacodynamic angiogenic cytokine profiling as downstream markers of EGFR and VEGF receptor (VEGFR) signaling. No objective responses were observed. Additional development of biomarkers for patient selection is needed to evaluate combined EGFR and VEGFR blockade as a therapeutic option in KRAS-mutated CRC.

Original languageEnglish (US)
Article number198
Pages (from-to)154-161
Number of pages8
JournalClinical Colorectal Cancer
Volume14
Issue number3
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Keywords

  • Antiangiogenic therapy
  • Biomarkers
  • Combination Therapy
  • Panitumumab imaging
  • Pharmacodynamics

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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