Journal Article

Maintenance of angiogenesis inhibition with aflibercept after progression to bevacizumab in metastatic colorectal cancer: real life study in the Valencian community

Rodríguez, Paula Llor, Bonastre, María Teresa Taberner, Veiga, Rebeca Chulvi, Sosa, Marcos Melian, Pérez, Irene Paredero, Abad, Laura Palomar, Aguilera, Maria José Safont, Urtasun, Jorge Aparicio, Raga, Mireia Gil, Hernández, Isabel Busquier

2023

Overview

Introduction The second-line chemotherapy in metastatic colorectal cancer (mCRC) with FOLFIRI-aflibercept demonstrated an increase in survival compared with FOLFIRI in patients previously treated with oxaliplatin-based regimens. Few data are available in patients treated previously with bevacizumab. Our objective is to evaluate the efficacy and safety of FOLFIRI-aflibercept in second-line treatment in patients who have previously received bevacizumab. Patients and methods This is a observational, retrospective study of patients with mCRC treated with FOLFIRI-aflibercept in 2nd line in eight hospitals in the Valencian Community. Survival, response, and toxicity were analyzed. Results 122 patients with a median age of 61 years were included. 89% of patients had PS 0–1. The median of PFS (progression free survival) and OS (overall survival) was 5.45 (95% CI 4.74–6.15 months) and 10.15 (95% CI 7.47–12.82 months), respectively. Disease control rate 59.8%. The most common grade 3–4 adverse events were neutropenia (13,1%) and asthenia (9%). The presence of hypertension during treatment with FOLFIRI-aflibercept was associated with a survival benefit. Median of OS was 14.45 (95% CI 11.58–17.32) in patients with hypertension vs 7.78 (95% CI 5.02–10.54) in patients without hypertension ( p  = .001). Our results suggest that the presence of PS 0, primary tumor surgery, metachronous metastases, and the presence of only 1 metastatic location, are favorable prognostic factors associated with better OS. Conclusions Our results confirm the value of maintaining angiogenesis inhibition with FOLFIRI-aflibercept in mCRC after progression to a first-line treatment with bevacizumab. The development of hypertension during treatment is a possible predictive marker of response.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Antineoplastic Combined Chemotherapy Protocols - adverse effects / Bevacizumab - therapeutic use / Camptothecin - therapeutic use / Colonic Neoplasms - drug therapy / Colorectal Neoplasms - pathology / Fluorouracil - adverse effects / Humans / Hypertension - chemically induced / Leucovorin - therapeutic use / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Metastasis - drug therapy / Oncology / Recombinant Fusion Proteins - therapeutic use / Rectal Neoplasms - drug therapy / Research Article / Retrospective Studies