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Despite treatment with the Folfox protocol and the Folfiri protocol about 50% of patients with metastatic colorectal cancer die within less than 2 years. Cetuximab, a monoclonal anti-EGFR antibody, has no proven impact on survival after failure of these protocols.

Panitumumab (Vectibix°, Amgen) is another monoclonal anti-EGFR antibody authorised for use in this setting, but only when tumour cells express EGFR and bear the wild-type (unmutated) KRAS gene.

The initial clinical evaluation only includes one randomised unblinded trial comparing panitumumab plus symptomatic treatment versus symptomatic treatment alone. The addition of panitumumab "significantly" increased the median progression- free survival time, but only by 5 days.

When the two most widely used protocols fail to control metastatic colorectal cancer, it is better to focus on maintaining patients’ quality of survival, by means of appropriate symptomatic treatment, rather than resort to panitumumab, which has more adverse effects than documented benefits.

©Prescrire August 2009

Source: Prescrire International 2009; 18 (102): 157.

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