Bevacizumab Improves the Overall and Progression-Free Survival of Patients with Metastatic Colorectal Cancer Treated with 5-Fluorouracil-Based Regimens Irrespective of Baseline Risk

Kabbinavar, Fairooz; Irl, Cornelia; Zurlo, Alfredo; Hurwitz, Herbert I.

doi:10.1159/000163850

Cited by 51 publications

(31 citation statements)

References 40 publications

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“…Bevacizumab is a humanized monoclonal antibody against VEGFA that inhibits angiogenesis. Bevacizumab has been demonstrated to improve response and progression-free survival compared with infusional 5-FU/leucovorin alone [97][98][99]. Combination therapy with FOLFOX was also shown to be associated with an improved pathologic response and a decrease in tumor viability on final pathology [100].…”

Section: Chemotherapy For Colorectal Hepatic Metastasesmentioning

confidence: 99%

Current management of colorectal hepatic metastasis

Mayo

Pawlik²

2009

Expert Review of Gastroenterology & Hepatology

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In the USA, cancers of the colon and rectum are the third most common site of new cancer cases and cancer deaths. With improved screening and adjuvant therapy, the survival of patients has increased substantially over the last decade. However, patients with metastatic disease often have limited survival. Hepatic metastasis is one of the most frequent sites of metastatic disease. In fact, 35-55% of patients with colorectal cancer will develop hepatic metastasis at some time during the course of their disease. Patients who are able to undergo complete resection of their hepatic metastases have the best chance of long-term survival. The goal of hepatic resection is to achieve complete resection of all metastases with microscopically negative surgical margins while preserving sufficient hepatic parenchyma. Survival following hepatic resection of colorectal metastasis now approaches 35-50%. However, approximately 65% of patients will have a recurrence at 5 years. Increasingly chemotherapeutic agents are being offered in the preoperative setting prior to operation. At the time of operation, patients with extensive hepatic disease can sometimes be offered ablative therapies combined with resection or staged approaches. Modern management of hepatic colorectal metastases necessitates a multidisciplinary approach to effectively treat these patients and increase the number of patients who will benefit from resection.

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Section: Chemotherapy For Colorectal Hepatic Metastasesmentioning

confidence: 99%

Current management of colorectal hepatic metastasis

Mayo

Pawlik²

2009

Expert Review of Gastroenterology & Hepatology

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“…21 Bevacizumab (Avastin; F. HoffmannLa Roche Ltd., Genentech, Inc., San Francisco, CA, USA) is one such humanized recombinant monoclonal antibody that binds to and blocks the activity of all isoforms of vascular endothelial growth factor-A (VEGF-A). 22,23 Studies show that bevacizumab in combination with commonly used chemotherapeutic agents demonstrates a higher response rate (RR), progression-free survival (PFS) and overall survival (OS) versus chemotherapy alone in patients with mCRC, 22,[24][25][26] along with an acceptable safety profile in patients with unresectable mCRC. 27 According to the National Cancer Institute, neoadjuvant therapy can be given as the first step to shrink a tumor before the main treatment, which is usually surgery.…”

mentioning

confidence: 99%

Neoadjuvant therapy of bevacizumab in combination with oxaliplatin and capecitabine (XELOX) for patients with metastatic colorectal cancer with unresectable liver metastases: a phase II, open‐label, single‐arm, noncomparative trial

Chen

Lin

Chen

et al. 2017

Asia-Pac J Clncl Oncology

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Aim: This phase II, open-label study evaluated the efficacy and safety of neoadjuvant therapy with bevacizumab plus XELOX (capecitabine and oxaliplatin) for untreated metastatic colorectal cancer with unresectable liver metastases and assessed conversion of unresectable to resectable metastases after neoadjuvant treatment. Methods:Patients received bevacizumab 5 mg/kg and oxaliplatin 85 mg/m 2 on day 1, and capecitabine 1000 mg/m 2 twice daily on days 1-5 followed by 2 days of rest in a 14-day cycle for 12 cycles; bevacizumab was excluded in cycles 6 and 7. Patients were later divided into resected and unresected groups, depending upon whether they underwent curative resection after chemotherapy. Efficacy and safety were evaluated.Results: Of 45 patients enrolled, 17.8% completed the study. The resection rate of liver metastases after neoadjuvant therapy was 42.2%. The median time to disease progression was 10.1 and 8.7 months in the resected and unresected groups, respectively (P = 0.1341). Response rate was significantly higher in the resected (47.4%) versus the unresected group (34.6%; P = 0.0010), and seven patients achieved complete response (resected group). Overall, 94.3% of adverse events were of mild or moderate severity, and grade ≥3 adverse events occurred in 4.3% and 7.3% of patients in the resected and unresected groups, respectively. The most common adverse events in both groups were palmar-plantar erythrodysesthesia syndrome, decreased appetite, thrombocytopenia, peripheral neuropathy, fatigue, diarrhea, vomiting, proteinuria and nausea. Conclusion:Neoadjuvant therapy with bevacizumab plus XELOX was well tolerated and effective in previously untreated metastatic colorectal cancer patients with initially unresectable liver metastases. K E Y W O R D Sbevacizumab, liver metastases, metastatic colorectal cancer, neoadjuvant therapy, XELOX

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“…Although the new regimens are costly, there is substantial evidence that these treatments improve survival. [16][17][18][19] Our analysis suggests that our price effects are independent of unobserved severity; however, our data are poorly suited to measuring any improved outcomes from new treatments.…”

Section: Discussionmentioning

confidence: 95%