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Int J Cancer. 2017 Jan 15;140(2):431-439. doi: 10.1002/ijc.30453. Epub 2016 Oct 17.

Dalotuzumab in chemorefractory KRAS exon 2 mutant colorectal cancer: Results from a randomised phase II/III trial.

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The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom.
Seoul National University College of Medicine, Seoul, Korea.
Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Internal Medicine, University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany.
College of Medicine, Yonsey Cancer Center, Yonsey University, Seoul, Korea.
Center for Colorectal Cancer, National Cancer Center, Seoul, Korea.
Department of Medicine, Division of Hematology/Oncology, Samsung Medical Center, Seoul, Korea.
Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway.
Concord Repatriation General Hospital, Concord, Sydney, Australia.
New Cross Hospital, Wolverhamptom, United Kingdom.
Karolinska University Hospital, Stockholm, Sweden.
Merck & Co, Inc, Whitehouse Station, NJ.


Limited data are available on the efficacy of anti-IGF-1R agents in KRAS mutant colorectal cancer (CRC). We analysed the outcome of 69 chemorefractory, KRAS exon 2 mutant CRC patients who were enrolled in a double-blind, randomised, phase II/III study of irinotecan and cetuximab plus dalotuzumab 10 mg/kg once weekly (arm A), dalotuzumab 7.5 mg/kg every second week (arm B) or placebo (arm C). Objective response rate (5.6% vs. 3.1% vs. 4.8%), median progression-free survival (2.7 vs. 2.6 vs. 1.4 months) and overall survival (7.8 vs. 10.3 vs. 7.8 months) were not statistically significantly different between treatment groups. Most common grade ≥3 treatment-related toxicities included neutropenia, diarrhoea, hyperglycaemia, fatigue and dermatitis acneiform. Expression of IGF-1R, IGF-1, IGF-2 and EREG by quantitative real-time polymerase chain reaction was assessed in 351 patients from the same study with available data on KRAS exon 2 mutational status. Median cycle threshold values for all biomarkers were significantly lower (i.e., higher expression, p < 0.05) among patients with KRAS wild-type compared to those with KRAS exon 2 mutant tumours. No significant changes were found according to location of the primary tumour with only a trend towards lower expression of IGF-1 in colon compared to rectal cancers (p = 0.06). Albeit limited by the small sample size, this study does not appear to support a potential role for anti-IGF-1R agents in KRAS exon 2 mutant CRC. Data on IGF-1R, IGF-1 and IGF-2 expression here reported may be useful for patient stratification in future trials with inhibitors of the IGF pathway.


EREG; IGF-1; IGF-1R; IGF-2; KRAS exon 2 mutation; cetuximab; chemorefractory colorectal cancer; dalotuzumab

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