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Purpose <p>Ramucirumab plus FOLFIRI is an established second-line treatment option for metastatic colorectal cancer (mCRC) after oxaliplatin-based first-line therapy. However, real-world data comparing outcomes according to prior biologic exposure are limited.</p> Methods <p>We retrospectively reviewed patients with mCRC who received second-line FOLFIRI plus ramucirumab after oxaliplatin- and fluoropyrimidine-based first-line therapy combined with either bevacizumab or an anti-EGFR antibody. Efficacy, safety, and subsequent treatment patterns were evaluated.</p> Results <p>Among 135 screened patients, 85 were included: 55 in the prior bevacizumab group and 30 in the prior anti-EGFR group. The prior anti-EGFR group was enriched for RAS wild-type tumors (100.0% vs. 12.7%) and left-sided primary tumors (90.0% vs. 58.2%). The objective response rate was 9.1% versus 33.3%, median progression-free survival was 6.1 versus 7.9 months, and median overall survival was 19.8 months (95% CI, 14.0-27.5) versus 31.5 months (95% CI, 11.0-37.8), respectively. Adverse events were manageable in both groups, without a marked increase in severe proteinuria in the prior bevacizumab group.</p> Conclusion <p>Second-line FOLFIRI plus ramucirumab showed clinically meaningful activity and manageable toxicity after either prior biologic strategy. The more favorable outcomes observed in the prior anti-EGFR cohort should be interpreted as hypothesis-generating because of baseline biologic imbalance and potential confounding.</p>

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Clinical Outcomes of Second-Line FOLFIRI Plus Ramucirumab According to Prior Biologic Exposure in Metastatic Colorectal Cancer: A Retrospective Comparison of Prior Bevacizumab and Prior Anti-EGFR Cohorts

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Tamotsu Sagawa,
  • Masahiro Hirakawa,
  • Shutaro Oiwa,
  • Atsushi Uesugi,
  • Makoto Yoshida,
  • Hiroyuki Nagashima,
  • Koshi Fujikawa

摘要

Purpose

Ramucirumab plus FOLFIRI is an established second-line treatment option for metastatic colorectal cancer (mCRC) after oxaliplatin-based first-line therapy. However, real-world data comparing outcomes according to prior biologic exposure are limited.

Methods

We retrospectively reviewed patients with mCRC who received second-line FOLFIRI plus ramucirumab after oxaliplatin- and fluoropyrimidine-based first-line therapy combined with either bevacizumab or an anti-EGFR antibody. Efficacy, safety, and subsequent treatment patterns were evaluated.

Results

Among 135 screened patients, 85 were included: 55 in the prior bevacizumab group and 30 in the prior anti-EGFR group. The prior anti-EGFR group was enriched for RAS wild-type tumors (100.0% vs. 12.7%) and left-sided primary tumors (90.0% vs. 58.2%). The objective response rate was 9.1% versus 33.3%, median progression-free survival was 6.1 versus 7.9 months, and median overall survival was 19.8 months (95% CI, 14.0-27.5) versus 31.5 months (95% CI, 11.0-37.8), respectively. Adverse events were manageable in both groups, without a marked increase in severe proteinuria in the prior bevacizumab group.

Conclusion

Second-line FOLFIRI plus ramucirumab showed clinically meaningful activity and manageable toxicity after either prior biologic strategy. The more favorable outcomes observed in the prior anti-EGFR cohort should be interpreted as hypothesis-generating because of baseline biologic imbalance and potential confounding.