Continuation or Reintroduction of Bevacizumab Improves Outcomes in Colorectal Cancer
the Cancer Therapy Advisor take:
The standard first-line treatment for metastatic colorectal cancer (mCRC) is the combination of bevacizumab, a monoclonal antibody that inhibits vascular endothelial growth factor (VEGF), and fluorouracil-based chemotherapy.
Two cohort studies (BRiTE and ARIES) and preclinical models have demonstrated that when established tumors are exposed to an anti-VEGF antibody for a longer period of time, it can delay tumor growth and extend survival.
Investigators sought to determine the efficacy of continuing or reintroducing bevacizumab in combination with second-line chemotherapy after the first progression in patients with mCRC. Two randomized trials were conducted: ML18147 trial and BEBYP trial; both studies were interrupted prematurely.
There were 185 patients treated with bevacizumab plus fluorouracil-based chemotherapy and were randomized to receive either second-line chemotherapy (mFOLFOX-6 or FOLFIRI) with or without bevacizumab. The primary end-point was progression-free survival, and 262 patients were needed to detect a hazard ration (HR) for progression of 0.70 with an α and β error of 0.05 and 0.20, respectively.
At a median follow-up of 45.3 months, the median progression free survival was 5.0 months in the chemotherapy-group and 6.8 months in the bevacizumab-group (adjusted HR=0.70; 95%CI 0.52-0.95; p=0.010). A subgroup analyses showed an enhanced overall survival in the bevacizumab group (adjusted HR=0.77; 95%CI 0.56-1.06; p=0.043).
Overall, the authors concluded that the continuation or the reintroduction of bevacizumab with second-line chemotherapy improves the outcome of patients with progressive mCRC, and thus support this strategy for the treatment of mCRC.
Standard treatment for mCRC is combination bevacizumab and fluorouracil-based chemotherapy.
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