Cetuximab and Combination Chemotherapy as First-Line Therapy in Treating Patients With Metastatic Colorectal Cancer

DISEASE CHARACTERISTICS:

* Histologically confirmed colorectal cancer

  * Metastatic, unresectable disease
* May or may not express the EGFR gene
* Measurable disease, defined as ≥ 1 measurable lesion by MRI or CT scan

  * Lesion must be outside an irradiated area

PATIENT CHARACTERISTICS:

* WHO performance status 0-1
* Life expectancy \> 3 months
* ANC ≥ 1,500/mm³
* Platelet count ≥ 100,000/mm³
* Hemoglobin ≥ 9 g/dL
* Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
* Transaminases ≤ 2.5 times ULN (5 times ULN if hepatic metastases are present)
* Creatinine ≤ 1.5 times ULN
* Not pregnant or nursing
* Fertile patients must use effective contraception
* No peripheral or symptomatic neuropathy ≥ grade 2 (NCI-CTCAE)
* No complete or partial intestinal blockage
* No intestinal inflammatory disease (e.g., Crohn's disease or ulcerative colitis)
* No chronic diarrhea
* No severe unstable cardiac disease (despite treatment)
* No myocardial infarction within the past 6 months
* No neurological or psychiatric illness, including epilepsy or dementia
* No uncontrolled active infection
* No other prior or concurrent malignancy within the past 5 years except for curatively treated basal cell skin cancer
* No psychological, familial, social, or geographic reason that would preclude study follow-up

PRIOR CONCURRENT THERAPY:

* No prior chemotherapy for metastatic disease

  * Prior fluorouracil-based adjuvant chemotherapy allowed provided it was administered ≥ 4 weeks ago
* At least 4 weeks since prior and no other concurrent experimental therapy
* No prior irinotecan hydrochloride, oxaliplatin, or monoclonal antibody
* No prior intestinal resection (e.g., hemicolectomy or extended resection of the small intestine)