Triplet chemotherapy with or without bevacizumab as first line treatment for metastatic colorectal cancer: An AGEO multicenter real-world study

R Varnier; C Toullec; S Philonenko; A Dupré; P Artru; E Hafliger; A Drouillard; C Torregrosa; S Pernot; P McLellan; T Lecomte; V Moulin; C Lécaille; Y Touchefeu; C Locher; J Taieb; C Coutzac

doi:10.1016/j.dld.2024.02.009

Triplet chemotherapy with or without bevacizumab as first line treatment for metastatic colorectal cancer: An AGEO multicenter real-world study

Dig Liver Dis. 2024 Feb 24:S1590-8658(24)00270-6. doi: 10.1016/j.dld.2024.02.009. Online ahead of print.

Authors

R Varnier¹, C Toullec², S Philonenko³, A Dupré⁴, P Artru⁵, E Hafliger⁵, A Drouillard⁶, C Torregrosa⁷, S Pernot⁸, P McLellan⁹, T Lecomte¹⁰, V Moulin¹¹, C Lécaille¹², Y Touchefeu¹³, C Locher¹⁴, J Taieb¹⁵, C Coutzac¹⁶

Affiliations

¹ Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Research on Healthcare Performance (RESHAPE, Inserm U1290), Université Claude Bernard Lyon 1, Lyon, France.
² Department of Digestive Oncology, Institut du Cancer Avignon-Provence, Avignon, France.
³ Department of Gastroenterology and Digestive Oncology, Hôpital Pitié Salpêtrière, Paris, France.
⁴ Department of Surgery, Centre Léon Bérard, Lyon, France.
⁵ Department of Gastroenterology and Digestive Oncology, Hôpital Privé Jean Mermoz, Lyon, France.
⁶ Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Dijon, Dijon, France.
⁷ Department of Medical Oncology, Institut Curie, Paris, France.
⁸ Department of Digestive Oncology, Institut Bergonié, Bordeaux, France.
⁹ Department of Hepato-Gastroenterology and Digestive Oncology, Hôpital Saint-Louis, Paris, France.
¹⁰ Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Tours, Tours, France.
¹¹ Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier de La Rochelle, La Rochelle, France.
¹² Department of Hepato-Gastroenterology and Digestive Oncology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.
¹³ Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
¹⁴ Department of Hepato-Gastroenterology, Centre Hospitalier de Meaux, Meaux, France.
¹⁵ Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris-Cité University, SIRIC CARPEM Comprehensive Cancer Center, Paris, France.
¹⁶ Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Association des Gastro-Entérologues Oncologues (AGEO), France. Electronic address: clelia.coutzac@lyon.unicancer.fr.

PMID: 38403514
DOI: 10.1016/j.dld.2024.02.009

Abstract

Background: Prior trials validated triplet chemotherapy (Tri-CT) with bevacizumab as first line treatment for metastatic colorectal cancer (mCRC) but real-world data are scarce and practices remain heterogeneous.

Aims: To evaluate Tri-CT +/- bevacizumab efficacy and safety, and to identify factors influencing treatment decisions.

Methods: The COLOTRIP retrospective study enrolled mCRC patients treated from 2014 to 2019 in 14 French centers.

Results: Of 299 patients (81% PS 0-1, 58% RAS-mutated and 19% BRAF-mutated), 51% received Tri-CT and 49% Tri-CT + bevacizumab. Metastatic disease was classified as resectable (6.5%), potentially resectable (40%), and unresectable (54%). Bevacizumab use was associated with primary tumor location, mutational status and number of metastases. Median overall survival was 33.5 months in the Tri-CT group and 23.9 months in the Tri-CT + bevacizumab group, with median progression-free survival being 14.5 and 11.4 months. After adjusting for initial characteristics, no difference in survival was noted. Around 30% of patients experienced grade ≥3 adverse events.

Conclusions: This study highlights several factors influencing Tri-CT use +/- bevacizumab decision and confirms the real-world good oncological outcomes and tolerability of these regimens in mCRC patients. Our results suggest that Tri-CT alone may by an appropriate option for specific subgroups of patients.

Keywords: Bevacizumab; Colorectal cancer; FOLFOXIRI; Triplet chemotherapy.