Cetuximab with oxaliplatin and capecitabine (CAPOX)in patients with metastatic colorectal cancer (mCRC) refractory to standard chemotherapy

Grothe, Wilfried; Arnold, Dirk; Peinert, Stefan; Voigt, Wieland; Loeffler, Luisa Mantovani; Siewczynski, R.; Steps, G.; Boehme, Julius; Graeven, U.; Schmoll, H.-J.

doi:10.1200/jco.2005.23.16_suppl.3669

Cited by 10 publications

(4 citation statements)

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“…In a recent presentation at the American Society of Clinical Oncology meeting, 15 patients with refractory CRC were treated with cetuximab and CAPOX. Only one patient had to stop treatment due to a grade 4 HSR [32]. Dakhil et al [33] reported a Phase II trial of cetuximab combined with FOLFOX6 as first-line therapy in patients with metatstaic CRC and noticed grade 3 HSR in 5% (4 out of 82) patients and no grade 4 HSR.…”

Section: Expert Opinionmentioning

confidence: 99%

Hypersensitivity reactions associated with oxaliplatin

Saif¹

2006

Expert Opinion on Drug Safety

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The reported incidence of hypersensitivity reactions (HSRs) associated with oxaliplatin in patients with colorectal cancer (CRC) is approximately 12%, with 1 - 2% of patients developing grade 3 or 4 in severity. However, the recent rising incidence of HSR to oxaliplatin observed is the result of increasing clinical use. HSR to oxaliplatin may manifest as facial flushing, rash/hives, tachycardia, dyspnoea, erythema, pruritus, fever, tongue swelling, headache, chills, weakness, vomiting, burning sensations, dizziness and oedema. Anaphylactic shock is rare but serious, and must be considered in the event of hypotension. No definitive approaches to prevent and treat HSR associated with oxaliplatin are available; however, few successful strategies have been reported. Such strategies include: slowing the infusion rate, use of steroids and antagonists of type 1 and 2 histamine receptors, and desensitisation. Successful implementation of oxaliplatin desensitisation protocols based on other platinum-containing compounds have been reported, which could enable a small number of patients who experience severe HSR to further receive an effective therapy for CRC. However, reintroductions have only been reported as single case studies or small cohorts. Large-scale validation on desensitisation strategies are still missing. Recently, subcutaneous adrenaline has also been utilised as an alternative approach to manage HSR to oxaliplatin. Knowledge of this rare but real toxicity of oxaliplatin is paramount because the use of this drug continues to increase not only for the treatment of patients with stage II-IV CRC, but also other solid malignancies. In this article, the author discusses the incidence, clinical presentation, pathogenesis, risk factors and current strategies of management of HSR associated with oxaliplatin.

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Section: Expert Opinionmentioning

confidence: 99%

Hypersensitivity reactions associated with oxaliplatin

Saif¹

2006

Expert Opinion on Drug Safety

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“…15 A small Phase II study investigating the combination of cetuximab, oxaliplatin, and capecitabine in a heavily pretreated mCRC population demonstrated acceptable tolerability and a partial response rate of 27 percent. 13 The adjuvant role of cetuximab is currently undergoing investigation in the ECOG N-0147 study in which patients are treated with cetuximab alone or cetuximab combined with FOLFOX for six months.…”

Section: Egfr-directed Monoclonal Antibodies For Colorectal Cancermentioning

confidence: 99%

EGFR-Targeted Therapies in Colorectal Cancer

Overman¹,

Hoff²

2007

Diseases of the Colon &Amp; Rectum

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The management of colorectal cancer relies heavily on the combination of the pyrimidine analog antimetabolite 5-fluorouracil with the platinum-based drug oxaliplatin or the topoisomerase inhibitor irinotecan. Optimization of dosing and scheduling of these agents to improve response and survival continues to evolve. Meanwhile, the rational targeting of molecular signaling pathways that are involved in the etiology of malignancies is currently one of the most promising strategies in novel anticancer drug development. New classes of drugs that target the epidermal growth factor receptor are among the most clinically advanced molecular-targeted therapies and have shown efficacy in colorectal cancer. The current status of epidermal growth factor receptor-targeted therapeutic agents is reviewed, with emphasis on their role in the management of colorectal cancer.

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“…The cetuximab-oxaliplatin plus capecitabine (CAPOX) combination was evaluated in a phase II study of 15 mCRC patients refractory to standard chemotherapy (including 5-FU, oxaliplatin, and irinotecan) [58]. The efficacy analysis indicated PR in 27%, stable disease (SD) in 27%, and [59]…”

Section: Second-or Third-line Combination Therapy In Refractory Crcmentioning

confidence: 99%