Avastin Plus Chemo for Metastatic Colorectal Cancer Increases Over Time

The rate of patients with metastatic colorectal cancer treated with the chemotherapy regimen FOLFOXIRI plus Avastin (bevacizumab) has increased over time, specifically in patients younger than 50 years old, recent study findings demonstrated.

Results from the study were presented at the 2024 ASCO Gastrointestinal Cancers Symposium.

FOLFOXIRI is a chemotherapy regimen consisting of fluorouracil, leucovorin, oxaliplatin and irinotecan, and is indicated as a first-line chemotherapeutic option for select patients with metastatic colorectal cancer.

Results from this study also demonstrated that the most frequent subsequent therapies following first- and second-line FOLFOXIRI plus Avastin included anti-epidermal growth factor receptor (EGFR) therapies, Lonsurf (trifluridine/tipiracil) and Stivarga (regorafenib).

Study Highlights:

  • A recent study at the 2024 ASCO Symposium revealed a rising use of FOLFOXIRI plus Avastin in metastatic colorectal cancer patients, especially under age 50.
  • FOLFOXIRI plus Avastin Regimen: The chemotherapy combo, comprising fluorouracil, leucovorin, oxaliplatin, and irinotecan, is recommended as a first-line treatment, showing improved progression-free survival.
  • Following FOLFOXIRI plus Avastin, patients commonly received anti-EGFR therapies, Lonsurf, and Stivarga, suggesting potential noncytotoxic treatments beyond the first-line setting.
  • Early-onset cases (under age 50) leaned towards aggressive chemotherapy, prompting the need for tailored approaches across age groups.
  • Most patients receiving FOLFOXIRI plus Avastin were aged 18 to 49, and were given the regimen primarily in the first-line setting. Understanding these patterns informs tailored follow-up options for metastatic colorectal cancer patients.

The median duration of first-line FOLFOXIRI plus Avastin was 25.1 weeks and 21.6 weeks for second-line use of the regimen. The median duration of FOLFOXIRI plus Avastin, with and without a KRAS mutation, was 26.1 weeks and 23.5 weeks in the first-line setting, respectively. For second-line use of the regimen, the median duration was 21.6 weeks in patients with a KRAS mutation and 16.5 weeks for those without the specific mutation.

After first-line FOLFOXIRI plus Avastin, the most frequently used new agents included anti-EGFR therapies like Erbitux (cetuximab) and Vectibix (panitumumab; 19%), trifluridine/tipiracil (12%) regorafenib (10%) and Xeloda (capecitabine; 3%). In the second-line setting, the most frequently used new agents were trifluridine/tipiracil (21%), anti-EGFR therapies (17%), regorafenib (15%) and Keytruda (pembrolizumab; 8%).

“This may suggest a role for noncytotoxic chemotherapy treatments, including EGFR inhibitors and regorafenib, beyond the first-line setting, which may be used to avoid further chemotherapy-related toxicities such as neutropenia (lower than normal number of neutrophils, a type of white blood cell), nausea and diarrhea,” the study authors wrote.

In this retrospective study, researchers used information obtained from a database from January 1, 2013, to February 28, 2023. In particular, the use of FOLFOXIRI plus Avastin and treatments following that regimen was assessed in patients aged 18 years and older with newly diagnosed metastatic colorectal cancer. The data from these patients were sorted by age (18 to 49, 50 to 64 and 65 years or older) and line of treatment. Of the 24,285 patients in this study, 38% of patients were aged 18 to 49 years, 44% were between the ages of 50 and 64, and 19% were 65 years and older at the index date.

“Evidence suggests that patients with early-onset (metastatic colorectal cancer) are more likely to receive aggressive multiagent chemotherapy, including (FOLFOXIRI plus Avastin), compared to patients with late-onset disease,” the study authors wrote. “Nevertheless, clinical treatment guidelines do not recommend different treatments by age group. Contemporary evidence is needed regarding the use of (FOLFOXIRI plus Avastin) and subsequent systemic treatments, across different age groups in patients with (metastatic colorectal cancer), to tailor appropriate follow-up treatment options in this patient group.”

When starting treatment, 35% were aged 18 to 49 years, 29% were between the ages of 50 and 64 years, and 14% were aged 65 years and older when starting treatment. The use of FOLFOXIRI plus Avastin in any line of treatment was the most prevalent in the patients aged 18 to 49 years (7%), followed by patients aged 50 to 64 years (3%) and those 65 years and older (1%). Two-thirds of the patient population (67%) received FOLFOXIRI plus Avastin in the first-line setting, whereas 23% received the regimen in the second-line setting. In addition, 57% were men and 34% of patients had a KRAS mutation, with 23% missing.

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