BACKGROUND: The addition of monoclonal antibodies targeting the epidermal growth factor receptor (anti-EGFR Abs) to chemotherapy for metastatic colorectal carcinoma (mCRC) is commonly delayed in the real-world clinical practice, usually because of late RAS testing results. OBJECTIVE: To determine whether delayed addition of anti-EGFR mAbs up to the fourth cycle of backbone chemotherapy adversely affected outcomes of mCRC patients treated with first-line regimens. PATIENTS AND METHODS: Clinical data of patients with histologically verified, RAS wild-type mCRC treated with first-line systemic therapy regimens containing anti-EGFR mAbs were retrospectively analysed from a national database. Patients were divided into three groups according to the timing of anti-EGFR mAbs addition to the chemotherapy backbone. Cohort A (n = 401) included patients in whom anti-EGFR mAbs were added to chemotherapy from the first cycle, cohort B (n = 71) patients with anti-EGFR mAbs added to chemotherapy from the second cycle, and cohort C (n = 101) patients who had anti-EGFR mAbs added to chemotherapy from the third or fourth cycle. RESULTS: Three hundred and thirty-six (58.6%) patients received panitumumab and 237 (41.4%) patients received cetuximab. The median progression-free survival (PFS) of the whole cohort was 12.2 months (95% confidence interval [CI] 10.9-13.5), and the median overall survival (OS) was 33.5 months (95% CI 27.6-39.4). The median PFS and OS for patients treated with anti-EGFR mAbs added to chemotherapy were 12.9 (95% CI 11.5-14.3) and 30.6 months (95% CI 25.2-36.1) for cohort A, 9.7 (95% CI 9.1-10.3) and not reached for cohort B, compared to 11.5 (95% CI 9.8-13.2) and 37.9 months (95% CI 28.6-47.3) for cohort C, respectively. CONCLUSIONS: Delayed addition of anti-EGFR mAbs to first-line chemotherapy was not associated with inferior survival or response rates.

Biomedical Center Faculty of Medicine in Pilsen Charles University Prague Czech Republic

Department of Comprehensive Cancer Care and Faculty of Medicine Masaryk Memorial Cancer Institute and Masaryk University Zluty kopec 543 7 656 53 Brno Czech Republic

Department of Oncology 1st Faculty of Medicine Charles University and Thomayer University Hospital Videnska 800 140 59 Prague Czech Republic

Department of Oncology General University Hospital and Charles University 1st Faculty of Medicine U Nemocnice 499 2 128 08 Prague Czech Republic

Department of Oncology Jihlava Hospital Comprehensive Cancer Centre Jihlava Czech Republic

Department of Oncology Motol University Hospital and 2nd Faculty of Medicine Charles University 5 Uvalu 84 150 00 Prague Czech Republic

Department of Oncology Palacky University Medical School and Teaching Hospital 1 P Pavlova 6 775 20 Olomouc Czech Republic

Department of Oncology T Bata Hospital and Comprehensive Cancer Centre Zlin Czech Republic

Department of Oncology University Hospital Svobody 80 304 60 Pilsen Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Netroufalky 5 625 00 Brno Czech Republic

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