Predictive Value of Other Oncogene Mutations for Anti-EGFR Monoclonal Antibodies Efficacy in Patients With Left-sided RAS-wild Type Metastatic Colorectal Cancer: Multicenter Randomized Phase III Trial
Patients meeting the inclusion criteria will be randomized 1:1 into Cohort A (n ≈ 177) or Cohort BC (n ≈ 177). Cohort A is the control: patients receive combination chemotherapy with FOLFOX plus anti-EGFR therapy (panitumumab or cetuximab) based on RAS/BRAF wild-type data, according to clinical guidelines. The BC cohort begins FOLFOX chemotherapy and simultaneously undergoes extensive molecular genetic profiling. Further, the BC cohort, depending on the profile, is divided into cohort B - patients without changes in alternative oncogenes, and cohort C - with changes in alternative oncogenes. The expected cohort ratio is 3:1 (\ 120 and \ 40 patients). Cohort B begins to receive anti-EGFR therapy in addition to chemotherapy, and the potentially resistant cohort C continues to receive chemotherapy alone or begins to receive bevacizumab if there are no contraindications.
• Informed consent signed before commencing any procedures related to the clinical trial.
• Age ≥18 years.
• ECOG status 0-2.
• Life expectancy greater than 12 weeks as assessed by the investigator.
• Verified diagnosis of colorectal adenocarcinoma (C18.5, C19, C20).
• Metastatic unresectable form of the disease that has not previously received any systemic therapy for the metastatic process (previous neo-/adjuvant therapy completed at least 6 months before the detection of metastases is allowed).
• Left-sided localization of the primary tumor (from the splenic flexure of the colon inclusive).
• Verified wild type KRAS, NRAS determined from tumor tissue.
• Satisfactory function of hematopoiesis and internal organs:
‣ absolute number of neutrophils ≥ 1.5×10 9 /l;
⁃ platelets ≥ 100×10 9 /l;
⁃ hemoglobin ≥ 90 g/l.
⁃ creatinine clearance above 50 ml/min;
⁃ total bilirubin \<1.5 X the upper limit of normal;
⁃ ALT or AST \>5 X the upper limit of normal in the presence of liver metastases or \>2.5 X the upper limit of normal in the absence of liver metastases.
⁃ Availability of a sufficient amount of tumor material for molecular genetic research. Tumor material must be collected no more than 24 months before inclusion in the study.