FOLFOXIRI-Bev May Improve Surgical Resection Rate in Colorectal Cancer

Fluorouracil, oxaliplatin, and irinotecan plus bevacizumab (FOLFOXIRI-Bev) yields “rapid and deep cytoreduction” that can improve patients’ opportunities for metastatic colorectal tumor resection, according to authors of a systematic review and meta-analysis published in JAMA Oncology.¹

FOLFOXIRI-Bev is a standard first-line chemotherapy regimen for patients with advanced colorectal cancer. The authors pooled analysis data from 11 phase 2 and 3 trials representing 889 patients, of whom overall response rates were clinically evaluable for 877 patients.

The resulting objective response rate was 69% (95% CI, 65%-72%). The overall surgical conversion rate was 39% (95% CI, 27%-53%), with curative surgery attempted in 28% (95% CI, 18-41%).

“In meta-regression analysis, variables significantly associated with conversion surgery were [metastatic] disease limited to the liver and a higher median number of [FOLFOXIRI-Bev] cycles (close to 12),” the authors noted.

For 6 studies from which overall survival (OS) data could be gleaned, the pooled median overall survival was 30.2 months (95% CI, 26.5-33.7 months).

Median progression-free survival (PFS), pooled from 9 studies, was 12.4 months.

The pooled analysis included data from small single-institution phase 2 studies that “could have overemphasized the final results.”

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“For patients with molecularly unselected and surgically unresectable metastatic CRC, triplet chemotherapy plus bevacizumab is able not only to control disease dissemination but induce rapid and deep cytoreduction that may translate into consistent probabilities to undergo secondary resection,” the authors concluded. 

Reference

1. Tomasello G, Petrelli F, Ghidini M, Russo A, Passalacqua R, Barni S. FOLFOXIRI plus bevacizumab as conversion therapy for patients with initially unresectable metastatic colorectal cancer: a systematic review and pooled analysis. JAMA Oncol. 2017 May 25. doi: 10.1001/jamaoncol.2017.0278 [Epub ahead of print]