A related commentary discusses this study. Taking the results at face value, it may appear that it would be reasonable to treat advanced, unresectable RASwt colorectal cancer with either FOLFOX or FOLFIRI in combination with either cetuximab or bevacizumab given that there were no significant differences between the regimens for overall survival or progression-free survival. However, with emerging data from several trials regarding right vs left-sided colon cancer, US guidelines for colon cancer now recommend consideration of EGFR therapy for patients with RASwt and left-sided tumors only in the first-line therapy setting. What cannot be determined from this study is the effect of subsequent therapy or if EGFR inhibitors can be effectively used inRASwt right-sided colon cancer for second-line treatment and beyond.
NICE TA439 recommends cetuximab, as an option for previously untreated EGFR, RAS wild-type metastatic colorectal cancer in adults in combination with 5‑fluorouracil, folinic acid and oxaliplatin (FOLFOX) or 5‑fluorouracil, folinic acid and irinotecan (FOLFIRI).