Abstract
Colorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient's profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.
Keywords:
Aflibercept; BRAF; Colorectal cancer; Metastatic; Mutation; Patient profile; Patient selection; RAS; Treatment.
MeSH terms
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Age Factors
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Angiogenesis Inhibitors / therapeutic use*
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Antineoplastic Agents, Immunological / therapeutic use
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Bevacizumab / therapeutic use
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Camptothecin / analogs & derivatives
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Camptothecin / therapeutic use
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Clinical Trials, Phase III as Topic
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Colorectal Neoplasms / drug therapy*
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Colorectal Neoplasms / genetics
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Colorectal Neoplasms / pathology
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Drug Substitution*
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Fluorouracil / therapeutic use
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Genes, ras
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Humans
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Leucovorin / therapeutic use
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Liver Neoplasms / secondary
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Liver Neoplasms / surgery
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Lung Neoplasms / secondary
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Lung Neoplasms / surgery
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Mutation
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Neovascularization, Pathologic / drug therapy
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Organoplatinum Compounds / therapeutic use
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Proto-Oncogene Proteins B-raf / genetics
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Receptors, Vascular Endothelial Growth Factor / therapeutic use*
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Recombinant Fusion Proteins / therapeutic use*
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Vascular Endothelial Growth Factor A / antagonists & inhibitors
Substances
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Angiogenesis Inhibitors
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Antineoplastic Agents, Immunological
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Organoplatinum Compounds
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Recombinant Fusion Proteins
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Vascular Endothelial Growth Factor A
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aflibercept
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Bevacizumab
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Receptors, Vascular Endothelial Growth Factor
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BRAF protein, human
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Proto-Oncogene Proteins B-raf
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Leucovorin
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Fluorouracil
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Camptothecin
Supplementary concepts
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Folfox protocol
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IFL protocol