Efficacy and safety of a biomarker-driven cetuximab-based treatment regimen over 3 treatment lines in mCRC patients with wild type tumors at start of first line: The CAPRI 2 GOIM trial.

Background: Monoclonal antibodies targeting EGFR such as cetuximab or panitumumab represent a major step forward in the treatment of wild type (WT) metastatic colorectal cancer (mCRC). Unfortunately, primary and acquired resistance mechanisms occur, with a huge percentage of patients succumbing to the disease. In the last years, mutation has been identified as the main molecular driver that determine resistance to anti-EGFR monoclonal antibodies. Liquid biopsy analysis allows to a dynamic and longitudinal assessment of mutational status during mCRC disease and has provided important information on the use of anti-EGFR drugs beyond progression or as rechallenge strategy in patients with WT tumors.

Methods: The phase II CAPRI 2 GOIM trial investigates the efficacy and safety of a bio-marker-driven cetuximab-based treatment regimen over 3 treatment lines in mCRC patients with WT tumors at start of first line.

Discussion: The aim of the study is to identify patients with WT tumors defined as "addicted" to an-anti EGFR based treatment along three lines of therapy. Moreover, the trial will evaluate the activity of cetuximab re-introduction in combination with irinotecan as 3 line therapy as rechallenge for patients that will be treated in second line with FOLFOX plus bevacizumab, having a mutant disease at progression after FOLFIRI plus cetuximab first line. A novel characteristic of this program is that the therapeutic algorithm will be defined at each treatment decision () in a prospective fashion in each patient by a liquid biopsy assessment of status by a comprehensive 324 genes Foundation One Liquid assay (Foundation/Roche).

Trial Registration: EudraCT Number: 2020-003008-15, ClinicalTrials.gov identifier: NCT05312398.