Impact of Consensus Molecular Subtype on Survival in Patients With Metastatic Colorectal Cancer: Results From CALGB/SWOG 80405 (Alliance)

Heinz-Josef Lenz, Fang-Shu Ou, Alan P Venook, Howard S Hochster, Donna Niedzwiecki, Richard M Goldberg, Robert J Mayer, Monica M Bertagnolli, Charles D Blanke, Tyler Zemla, Xueping Qu, Pratyaksha Wirapati, Sabine Tejpar, Federico Innocenti, Omar Kabbarah, Heinz-Josef Lenz, Fang-Shu Ou, Alan P Venook, Howard S Hochster, Donna Niedzwiecki, Richard M Goldberg, Robert J Mayer, Monica M Bertagnolli, Charles D Blanke, Tyler Zemla, Xueping Qu, Pratyaksha Wirapati, Sabine Tejpar, Federico Innocenti, Omar Kabbarah

Abstract

Purpose: To determine the predictive and prognostic value of the consensus molecular subtypes (CMSs) of colorectal cancer (CRC) that represent a merging of gene expression-based features largely in primary tumors from six independent classification systems and provide a framework for capturing the intrinsic heterogeneity of CRC in patients enrolled in CALGB/SWOG 80405.

Patients and methods: CALGB/SWOG 80405 is a phase III trial that compared the addition of bevacizumab or cetuximab to infusional fluorouracil, leucovorin, and oxaliplatin or fluorouracil, leucovorin, and irinotecan as first-line treatment of advanced CRC. We characterized the CMS classification using a novel NanoString gene expression panel on primary CRCs from 581 patients enrolled in this study to assess the prognostic and predictive value of CMSs in these patients.

Results: The CMSs are highly prognostic for overall survival (OS; P < .001) and progression-free survival (PFS; P < .001). Furthermore, CMSs were predictive for both OS (P for interaction < .001) and PFS (P for interaction = .0032). In the CMS1 cohort, patients treated with bevacizumab had a significantly longer OS than those treated with cetuximab (P < .001). In the CMS2 cohort, patients treated with cetuximab had a significantly longer OS than patients treated with bevacizumab (P = .0046).

Conclusion: These findings highlight the possible clinical utility of CMSs and suggests that refinement of the CMS classification may provide a path toward identifying patients with metastatic CRC who are most likely to benefit from specific targeted therapy as part of the initial treatment.

Trial registration: ClinicalTrials.gov NCT00265850.