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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECross-talk between vascular endothelial growth factor (VEGF) and the epidermal growth factor receptor (EGFR) are involved in tumor growth and survival; inhibition of either may increase survival in patients with metastatic colorectal cancer (mCRC). However, combining monoclonal antibodies (mAb) targeting VEGF or EGFR in mCRC has not been effective. This article reports on the final results of the Optimized Chemotherapy Followed by Maintenance With Bevacizumab With or Without Erlotinib in Treating Patients With Metastatic Colorectal Cancer That Cannot Be Removed by Surgery study [DREAM; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00265824\u0026amp;atom=%2Fspmdc%2F14%2F36%2F10.atom\u0022\u003ENCT00265824\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ECross-talk between vascular endothelial growth factor (VEGF) and the epidermal growth factor receptor (EGFR) are involved in tumor growth and survival; inhibition of either may increase survival in patients with metastatic colorectal cancer (mCRC). However, combining monoclonal antibodies (mAb) targeting VEGF or EGFR in mCRC has not been effective [Hecht JR et al. J Clin Oncol. 2009; Tol J et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2009]. Benoit Chibaudel, MD, Saint-Antoine Hospital, Paris, France, reported the final results of the Optimized Chemotherapy Followed by Maintenance With Bevacizumab With or Without Erlotinib in Treating Patients With Metastatic Colorectal Cancer That Cannot Be Removed by Surgery study [DREAM; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00265824\u0026amp;atom=%2Fspmdc%2F14%2F36%2F10.atom\u0022\u003ENCT00265824\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDREAM was a randomized, phase 3 trial in patients with unresectable mCRC testing the combination of bevacizumab (BEV), a mAb that targets VEGF, with erlotinib (ERL), a tyrosine kinase inhibitor targeting EGFR, as maintenance therapy in mCRC.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAll patients (n = 694) received 1 of 3 induction regimens, all of which contained BEV, and only those patients whose disease did not progress (n = 452 or 65% of the registered population) were randomly assigned to maintenance therapy with BEV (n = 228) or BEV + ERL (n = 224). The primary end point was progression-free survival (PFS) from randomization. Secondary end points included overall survival (OS), PFS from registration, response according to KRAS status, and adverse events.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EBaseline characteristics were similar between treatment arms at registration and at randomization. The induction response rate was 55% complete or partial response for patients randomized to BEV vs 58% for those randomized to BEV + ERL; stable disease was 46% vs 42%, respectively. The treatment delivery was similar for both arms, but the BEV + ERL arm received 12% more BEV cycles and 30% of the ERL doses given were a reduced dose. Results at a median follow-up of 50 months of maintenance therapy are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. BEV + ERL was generally favored for maintenance PFS and OS in a subgroup analysis. Maintenance response rates were significantly higher with BEV + ERL, including among the subgroup of patients with mutant KRAS.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12094\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12094\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12094\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EResults from the DREAM Trial\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThere was increased toxicity of any grade in the BEV + ERL arm for nausea, mucositis, diarrhea, and skin rash. Grade 3\/4 toxicities were increased for diarrhea, skin rash, and nausea in the BEV + ERL arm.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe same proportion of patients in both arms received the same postprogression therapy, including oxaliplatin reintroduction, irinotecan-based second-line therapy, or anti-EGFR mAb. Survival in patients who received postprogression therapy, including anti-EGFR mAb, is similar in both arms.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn patients with mCRC, induction therapy followed by maintenance therapy with BEV + ERL significantly improves maintenance PFS, PFS from registration, OS from maintenance, and OS from registration compared with the same induction therapy followed by BEV monotherapy. This effect is independent of the KRAS mutational status; a significant difference in response rate is observed during the chemotherapy-free maintenance therapy in KRAS mutated tumors.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe safety of BEV + ERL is acceptable despite increased incidence of severe skin rash and diarrhea. The survival benefit for BEV + ERL is independent of the subsequent therapy. Anti-EGFR mAb remains active in patients who received prior erlotinib. BEV and a short period of ERL therapy may provide a new treatment option in first-line therapy following induction chemotherapy with BEV for patients with unresectable mCRC.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/36\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm01q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm01q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}