Individual Patient Data Meta-Analysis of FOLFOXIRI Plus Bevacizumab Versus Doublets Plus Bevacizumab as Initial Therapy of Unresectable Metastatic Colorectal Cancer

Analysis of individual patient data from 5 trials (n=1,687) found FOLFIRI plus bevacizumab is associated with an overall survival advantage over doublets plus bevacizumab (median OS 28.9 v 24.5 months; HR 0.81; 95% CI, 0.72 to 0.91; P<0.001; no significant heterogeneity).

SPS commentary:

The authors note that there was a higher incidence of grade 3 and 4 gastrointestinal and haematological adverse events associated with the upfront use of FOLFOXIRI + bevacizumab, and that an appropriate selection of candidate patients is necessary to minimise the impact of toxicity and maximise treatment efficacy.  The majority of patients included in the analysis had an ECOG performance status of 0 or 1, and the median age was 61 years. Only 20% had RAS or BRAF wild-type tumour, and the authors note that assessment of the value of the addition of bevacizumab to FOLFOXIRI or the comparative efficacy versus doublets plus anti-EGFR in patients with RAS wild-type tumours was out of the reach of their analysis.

Journal of Clinical Oncology