FOLFOXIRI–Bevacizumab ORR Allows Secondary Resection For Metastatic CRC

FOLFOXIRI–Bevacizumab ORR Allows Secondary Resection For Metastatic CRC
Surgery is feasible in a significant proportion of patients with initially unresectable metastatic colorectal cancer after FOLFOXIRI–bevacizumab regimen

Date: 30 May 2017
Author: By Lynda Williams, Senior medwireNews Reporter
Topic: Anti-Cancer Agents & Biologic Therapy / Colon Cancer / Rectal Cancer

medwireNews: Almost 40% of patients with unresectable metastatic colorectal cancer (CRC) may be eligible for surgery after treatment with fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI) plus bevacizumab, say researchers who analysed data gathered from 11 clinical trials.

“Our findings show that FOLFOXIRI-[bevacizumab] represents a very effective therapeutic combination associated with a significant ORR [objective response rate]”, report Fausto Petrelli, from Piazzale Ospedale in Treviglio, Italy, and team in JAMA Oncology.

Data were available for 889 patients with initially unresectable CRC metastases, 877 of whom were evaluated for clinical response. The rate of liver-limited metastatic disease varied between the trial groups from 18–100%.

The pooled ORR for FOLFOXIRI–bevacizumab regimen was 69.0%. This resulted in conversion to surgery in 39.1% of the patients, with 28.1% achieving R0 resection at all surgical sites, the team says.

Pooled data available for six trials gave a median overall survival of 30.2 months, while pooled findings from nine trials gave a median progression-free survival of 12.4 months.

The researchers say that the survival outcomes, “although not striking, are highly consistent with those reported in the phase 3 TRIBE trial, probably reflecting the poor prognostic baseline characteristics of a population of patients with extensive metastatic involvement who were unselected for secondary resection intent.”

Fausto Petrelli et al conclude: “For patients with molecularly unselected and surgically unresectable metastatic CRC, triplet chemotherapy plus bevacizumab is able to not only control disease dissemination but induce rapid and deep cytoreduction that may translate into consistent probabilities to undergo secondary resection.

“Therefore, a multidisciplinary approach to advanced CRC is crucial to guarantee an optimal integration of highly active upfront treatments with surgical procedures to ultimately improve patients’ long-term outcome.”

Reference

Tomasello G, Petrelli F, Ghidini M, et al. FOLFOXIRI plus bevacizumab as conversion therapy for patients with initially unresectable metastatic colorectal cancer. A systematic review and pooled analysis. JAMA Oncol; Advance online publication 25 May 2017. doi:10.1001/jamaoncol.2017.0278