Fiche publication
Date publication
avril 2026
Journal
Signal transduction and targeted therapy
Auteurs
Membres identifiés du Cancéropôle Est :
Pr GHIRINGHELLI François
,
Mme HENRIQUES Julie
Tous les auteurs :
Chibaudel B, Dourthe LM, André T, Henriques J, Bourgeois V, Etienne PL, Desramé J, Carola E, Dupuis O, Baba-Hamed N, Auby D, Louvet C, Maillard E, Romano O, Tournigand C, Garcia-Larnicol ML, Shacham-Shmueli E, Bird BH, Ghiringhelli F, de Gramont A
Lien Pubmed
Résumé
Managing unresectable metastatic colorectal cancer (mCRC) requires a comprehensive strategy. While chemotherapy, anti-angiogenic, and anti-epidermal growth factor receptor (EGFR) agents are available, strategy trials are needed to optimize their use and sequencing. The STRATEGIC-1 phase III trial (NCT01910610) was designed to determine the optimal treatment sequence in patients with untreated, unresectable wild-type RAS/BRAF mCRC. Patients were randomized (1:1) to FOLFIRI-cetuximab then mFOLFOX6-bevacizumab (arm A) or OPTIMOX-bevacizumab then FOLFIRI-bevacizumab followed by EGFR monoclonal antibody +/- irinotecan (arm B). The primary endpoint was the duration of disease control (DDC). Secondary endpoints were overall survival (OS), time to failure of strategy (TFS), progression-free survival (PFS), overall response rate (ORR), salvage surgery rate, safety, and health-related quality of life (HRQoL). Overall, 263 patients (arm A:131, arm B:132) were randomized. After 68.4 months of median follow-up (95% CI, 76.5-98.0), the median DDC was 22.8 months (95% CI, 20.4-28.8) in arm A and 23.5 months (95% CI, 17.9-26.3) in arm B (HR = 1.01, 95% CI, 0.76-1.34; log-rank P = 0.945). The median OS was 40.4 months (95% CI, 32.4-51.1) in arm A and 34.4 months (95% CI, 27.5-42.2) in arm B (HR = 1.30, 95% CI, 0.99-1.72). The ORR was higher in arm A (82.4% versus 65.4%) in the first-line group but not in the second-line group (20.7% versus 16.4%). Adverse events were consistent with the well-known safety profiles. STRATEGIC-1 did not meet its primary endpoint and was inconclusive in identifying the optimal treatment strategy in wild-type RAS/BRAF mCRC.
Mots clés
Humans, Colorectal Neoplasms, drug therapy, Female, Male, Middle Aged, Antineoplastic Combined Chemotherapy Protocols, administration & dosage, Proto-Oncogene Proteins B-raf, genetics, Aged, Adult, Bevacizumab, administration & dosage, Neoplasm Metastasis, Leucovorin, administration & dosage, Fluorouracil, administration & dosage, Camptothecin, analogs & derivatives, Irinotecan, administration & dosage, Cetuximab, administration & dosage, Quality of Life, ras Proteins, genetics, Aged, 80 and over
Référence
Signal Transduct Target Ther. 2026 04 14;11(1):
