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Colorectal Cancer — SCE Medical Oncology MCQ

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HardGI CancersColorectal CancerSCE Medical Oncology

A 55-year-old woman with metastatic colon cancer on FOLFOX + bevacizumab undergoes routine surveillance CT showing an excellent partial response. She asks about the FIRE-3 trial. What was the key finding of FIRE-3?

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Correct answer: A — In KRAS exon 2 wild-type metastatic CRC, FOLFIRI + cetuximab improved OS compared with FOLFIRI + bevacizumab, though PFS was similar — supporting anti-EGFR over anti-VEGF in RAS wild-type, left-sided disease

FIRE-3 was a landmark randomised phase III trial comparing FOLFIRI + cetuximab vs FOLFIRI + bevacizumab as first-line therapy for KRAS exon 2 wild-type metastatic CRC. While PFS was similar, OS was significantly better with cetuximab (28.7 vs 25.0 months). Combined with the PARADIGM trial (which showed OS benefit for panitumumab + mFOLFOX6 vs bevacizumab + mFOLFOX6 in left-sided, RAS wild-type CRC), this established anti-EGFR therapy as preferred for left-sided RAS/BRAF wild-type mCRC.

Reference: ESMO 2024 mCRC Guidelines; FIRE-3 Heinemann et al Lancet Oncol 2014; PARADIGM Yoshino et al Lancet Oncol 2023