22 Oct Metastatic Colon Cancer: Survival Improved With FOLFOXIRI and Bevacizumab
MedicalResearch.com Interview with:
Alfredo Falcone MD
Chiara Cremolini Fotios Loupakis
University of Pisa and Azienda-Ospedaliero Universitaria Pisana
Italy
Medical Research: What are the main findings of the study?
Dr. Falcone: In the TRIBE study the main findings are that the use of an initial more intensive therapy with a triplet of cytotoxics (FOLFOXIRI) plus bevacizumab vs a doublet (FOLFIRI) + bevacizumab improves the outcome of metastatic colorectal cancer patients with unresectable metastases. In particular FOLFOXIRI + bevacizumab vs FOLFIRI+bevacizumab improved RECIST response-rate (65% vs 53%, p=0.006), progression-free survival which was the primary endpoint (median 12,1 vs 9,7 months, HR=0,75, p=0.003) and overall survival (median 31,0 vs 25,8 months, HR=0.79, p=0.054). These results, also compared to those reported in previous phase III studies in molecularly unselected patients, represent an important advance in the treatment of this disease.
Medical Research: What was most surprising about the results?
Dr. Falcone: That the improvement in the outcome with FOLFOXIRI+bevacizumab was observed despite the fact that no improvement in the secondary R0 resection rate of metastases was observed (15% vs 12%, p=0.33). This indicates that FOLFOXIRI+bevacizumab is a more effective therapy also in a palliative setting where secondary surgery of metastases is not a reasonable objective of the treatment.
Medical Research: What should clinicians and patients take away from your report?
Dr. Falcone: To consider an initial intensive therapy with FOLFOXIRI+bevacizumab, followed by maintenance with 5-FU/LV and bevacisumab, as a very good option for many metastatic colorectal cancer patients with a good ECOG Performace-status (0-1), no relevant comorbidities and age < 70-75 yrs, independently from the molecular characteristcs of the tumor. In patients with RAS mut or BRAF mut tumors FOLFOXIRI+bevacizumab may represent today the best option.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Falcone: First of all to update the overall survival of the TRIBE study to estimate the long-term benefit of FOLFOXIRI+bevacizumab.
In the meantime, to improve the tolerance of the regimen, and perhaps its efficacy, by reducing the duration of the induction phase from 6 to 4 months, followed by a maintenance with bevacizumab and a low toxic metronomic chemotherapy, followed by a re-treatment with FOLFOXIRI+bevacizumab at the first progression (MOMA study).
In the RAS-wt patients it is of great interest to study the triplet FOLFOXIRI in combination with anti-EGFR mAbs and also these studies are ongoing with preliminary promising results (MACBETH study).
Citation:
Initial Therapy with FOLFOXIRI and Bevacizumab for Metastatic Colorectal Cancer
N Engl J Med 2014; 371:1609-1618
October 23, 2014
Last Updated on October 24, 2014 by Marie Benz MD FAAD