Cetuximab rechallenge plus avelumab for pretreated RAS wild-type metastatic colorectal cancer

Rechallenge therapy with anti-epidermal growth factor drugs has been suggested for chemo-refractory RAS wild-type mCRC. The multicenter Italian phase 2 CAVE study included patients after response to first-line chemotherapy plus anti-EGFR drugs, who developed resistance and failed second-line therapy. In third or later line the patients received avelumab plus cetuximab rechallenge. The study met its primary end point with a median OS of 11.6 months, while median OS reached 17.3 months in patients with baseline RAS/BRAF wild-type ctDNA. The toxic effects were mild. The authors conclude that avelumab plus cetuximab rechallenge is an active, well tolerated therapy in RAS wild-type mCRC. Plasma ctDNA analysis before treatment may allow selection of patients who could benefit.