Bevacizumab should not be used with capecitabine as an adjuvant treatment for colorectal cancer, according to a study published in The Lancet Oncology.1

Although surgery for colorectal cancer is often curative, up to half of patients will relapse, usually due to neoangiogenesis. Bevacizumab is an effective antiangiogenic treatment used in conjunction with capecitabine in advanced colorectal cancer, though it was undetermined whether this combination would be efficacious in the adjuvant setting.

Researchers designed the QUASAR 2 (Adjuvant capecitabine plus bevacizumab versus capecitabine alone in patients with colorectal cancer; Identifier: NCT00005586) trial to contrast the efficacy of capecitabine with that of capecitabine and bevacizumab among patients with either high-risk stage II or stage III disease.

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Among 7475 assessed patients, 968 patients randomized to receive capecitabine only, and 973 randomized to receive capecitabine plus bevacizumab, were included in the final analysis. Patient biomarkers were not evaluated before the study.

Results were mixed, but no significant difference in either progression-free or overall survival was found. Serious adverse events were more common in the combination cohort (350 versus 221). There were 8 treatment-related deaths among those receiving capecitabine only, and 15 in the bevacizumab cohort.

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The authors conclude that bevacizumab should not be used with capecitabine in the adjuvant setting. The results may, however, be “hypothesis generating,” as future studies might evaluate specific biomarkers before re-evaluating the efficacy of bevacizumab as an adjuvant therapy.


  1. Kerr RS, Love S, Segelov E, et al. Adjuvant capecitabine plus bevacizumab versus capecitabine alone in patients with colorectal cancer (QUASAR 2): an open-label, randomised phase 3 trial. Lancet Oncol. 2016 Sep 19. doi: 10.1016/S1470-2045(16)30172-3 [Epub ahead of print]