Fluoropyrimidine, Bevacizumab Plus Oxaliplatin for Older Patients With Unresectable Metastatic Colorectal Cancer

In patients with unresectable metastatic colorectal cancer, the recommended treatment regimen includes doublet chemotherapy with fluoropyrimidine and oxaliplatin plus bevacizumab. However, there is little research on the efficacy of adding oxaliplatin to treat older patients with the disease.

An open-label, phase 3 study from Atsuo Takashima, MD, and colleagues published in the Journal of Clinical Oncology investigated the effects of adding oxaliplatin to fluoropyrimidine plus bevacizumab for older patients with unresectable metastatic colorectal cancer.

Patients were randomly assigned to receive either fluoropyrimidine plus bevacizumab or fluoropyrimidine plus bevacizumab and oxaliplatin. The study’s primary endpoint was progression-free survival (PFS).

Of the participants, 125 received fluoropyrimidine plus bevacizumab, while 126 received fluoropyrimidine plus bevacizumab and oxaliplatin. Patients in the study presented with unresectable metastatic colorectal cancer who were older than 70 years and had an Eastern Cooperative Oncology Group performance status between 0 and 2.

The median PFS in the control arm was 9.4 months (95% CI, 8.3-10.3) and 10.0 months in the oxaliplatin arm (95% CI, 0.67-1.04). Median overall survival was 21.3 months (95% CI, 18.7-24.3) in the fluoropyrimidine plus bevacizumab alone group and 19.7 months (95% CI, 15.5-25.5) in the oxaliplatin group.

Dr. Takashima and colleagues reported that grade 3 or higher adverse events were more commonly reported in the fluoropyrimidine plus bevacizumab and oxaliplatin cohort (52% vs 69%). In the control arm, 1 treatment-related death was reported, while 3 treatment-related deaths were reported in the oxaliplatin arm.

“No benefit of adding oxaliplatin to fluoropyrimidine plus bevacizumab as first-line treatment was demonstrated in older patients with unresectable metastatic colorectal cancer,” the researchers wrote. “Fluoropyrimidine plus bevacizumab is recommended for this population.”