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Treatment with cetuximab, bevacizumab and irinotecan in heavily pretreated patients with metastasized colorectal cancer.

BACKGROUND
Modern therapy algorithms for advanced colorectal cancer include the monoclonal antibodies bevacizumab and cetuximab. Routinely, these antibodies are given sequentially in combination with chemotherapy. The question whether a combination of bevacizumab and cetuximab is beneficial has not been answered. The results of the BOND-2 study showed that tumor drug resistance to irinotecan can be overcome by addition of both cetuximab and bevacizumab.


PATIENTS AND METHODS
Here, we present the cases of five patients who were heavily pretreated and already had received cetuximab (and in two cases also bevacizumab). These patients received a chemotherapeutic regimen consisting of irinotecan, cetuximab and bevacizumab.


RESULTS
The combination of these two antibodies with irinotecan surprisingly induced marked tumor response in four out of five patients.


CONCLUSION
There are currently no published data concerning the question whether resistance against one monoclonal antibody can be overcome by the addition of another monoclonal antibody. These cases point to a possible novel treatment approach and provide an incentive for further experimental investigations. The treatment was well tolerated and should be considered as a further medical treatment strategy.