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VALENTINO Study: Maintenance Therapy in Advanced CRC

Insights from: Wells A. Messersmith, MD, FACP, University of Colorado Cancer Center
Published: Wednesday, Jun 20, 2018



Transcript: 

Wells A. Messersmith, MD, FACP: The VALENTINO trial is one of a number of studies looking at what the best maintenance approach is. We know that combination chemotherapy is effective in colorectal cancer, but you can’t continue it forever. Patients really get too many side effects; there are cumulative side effects. And so, the question is, what type of maintenance approach can we use following an initial period of aggressive combination chemotherapy, where the patients would continue to get benefit and we don’t lose efficacy? The question that the VALENTINO study addressed was, can you use maintenance therapy with panitumumab alone, or do you need to use panitumumab plus 5-FU? Multiple studies have shown the benefit of continuing with 5-FU maintenance, so this was the EGFR inhibitor versus the EGFR inhibitor plus 5-FU in the maintenance setting following first-line colorectal cancer therapy.

The upshot of the trial was essentially that maintenance with 5-FU is needed. In other words, the more controlled arm where 5-FU was given with panitumumab outperformed panitumumab alone, indicating that for whatever reason—we don’t fully understand the biology of this—we need to continue the 5-FU. The practice implications are simply that we don’t change what we’ve been doing now for several years, which is that 5-FU should be the basis of any maintenance approach whether or not patients receive targeted therapy, such as a VEGFR-targeting therapy like bevacizumab or an EGFR-targeting therapy like panitumumab or cetuximab, in addition to 5-FU. That would really be a question for the individual provider, depending on toxicities and other things. But this trial indicates that we do seem to need 5-FU if we’re going to try to use an EGFR inhibitor in the maintenance setting.

Transcript Edited for Clarity 
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Transcript: 

Wells A. Messersmith, MD, FACP: The VALENTINO trial is one of a number of studies looking at what the best maintenance approach is. We know that combination chemotherapy is effective in colorectal cancer, but you can’t continue it forever. Patients really get too many side effects; there are cumulative side effects. And so, the question is, what type of maintenance approach can we use following an initial period of aggressive combination chemotherapy, where the patients would continue to get benefit and we don’t lose efficacy? The question that the VALENTINO study addressed was, can you use maintenance therapy with panitumumab alone, or do you need to use panitumumab plus 5-FU? Multiple studies have shown the benefit of continuing with 5-FU maintenance, so this was the EGFR inhibitor versus the EGFR inhibitor plus 5-FU in the maintenance setting following first-line colorectal cancer therapy.

The upshot of the trial was essentially that maintenance with 5-FU is needed. In other words, the more controlled arm where 5-FU was given with panitumumab outperformed panitumumab alone, indicating that for whatever reason—we don’t fully understand the biology of this—we need to continue the 5-FU. The practice implications are simply that we don’t change what we’ve been doing now for several years, which is that 5-FU should be the basis of any maintenance approach whether or not patients receive targeted therapy, such as a VEGFR-targeting therapy like bevacizumab or an EGFR-targeting therapy like panitumumab or cetuximab, in addition to 5-FU. That would really be a question for the individual provider, depending on toxicities and other things. But this trial indicates that we do seem to need 5-FU if we’re going to try to use an EGFR inhibitor in the maintenance setting.

Transcript Edited for Clarity 
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