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ASCO 2026 | CR-SEQUENCE: chemotherapy sequencing in RAS wild-type left-sided mCRC
Ramon Salazar, MD, PhD, Institut Català D’Oncologia, Barcelona, Spain, presents results from the Phase III CR-SEQUENCE trial (2024-510967-41-00) of panitumumab- versus bevacizumab-based first-line sequencing strategies in previously untreated RAS wild-type, left-sided unresectable metastatic colorectal cancer (mCRC). While the primary endpoint of 36-month progression-free survival rate was not met, starting with panitumumab-based therapy yielded superior first-line efficacy and a higher objective response rate, which may be clinically relevant in select patients. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
This is about patients with left-sided, RAS-wild type, metastatic colorectal cancer. And in the CR sequence trial, we are testing whether the order of biologics with chemo in first and second line makes a difference. We randomize the patients to two different sequences. First line, Panitumumab and FOLFOX, and upon progression after first line, Bevacizumab, FOLFOX, or the reverse sequence...
This is about patients with left-sided, RAS-wild type, metastatic colorectal cancer. And in the CR sequence trial, we are testing whether the order of biologics with chemo in first and second line makes a difference. We randomize the patients to two different sequences. First line, Panitumumab and FOLFOX, and upon progression after first line, Bevacizumab, FOLFOX, or the reverse sequence. So sequence one is anti-EGFR first. The primary endpoint was 36 months PFS rate. Secondary endpoints were response rate and PFS after first line, overall survival, and ctDNA program for hyperselection subgroup analysis. The results are the following. Primary objective was not met. There was a numerical difference in 36 months PFS rate in favor of sequence one, Panitumumab first, but this was not statistically significant. On the contrary, secondary endpoints of first-line therapy did show a statistically significant advantage to sequence 1, Panitumumab first, in terms of PFS and response rate. Interestingly, response rate was as high as 81% in sequence one versus 64% in sequence two. And overall survival data is still immature, but there’s a numerical difference of 64 versus 59 median survival that we will track down in the near future.
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