Impact of age and gender on the safety and efficacy of chemotherapy plus bevacizumab in metastatic colorectal cancer: a pooled analysis of TRIBE and TRIBE2 studies

Marmorino, Federica; Rossini, Daniele; Lonardi, Sara; Moretto, Roberto; Zucchelli, Gemma; Aprile, Giuseppe; Dell’Aquila, Emanuela; Ratti, Margherita; Bergamo, Francesca; Masi, Gianluca; Urbano, Federica; Ronzoni, Monica; Libertini, Michela; Borelli, Beatrice; Randon, Giovanni; Buonadonna, Angela; Allegrini, Giacomo; Pella, Nicoletta; Ricci, Vincenzo; Boccaccino, Alessandra; Latiano, Tiziana Pia; Cordio, S.; Passardi, Alessandro; Tamburini, Emiliano; Boni, Luca; Falcone, Alfredo; Cremolini, Chiara

doi:10.1093/annonc/mdz403

Cited by 28 publications

(30 citation statements)

References 13 publications

(20 reference statements)

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“…When looking at specific adverse events, only neutropenia was significantly more frequent with the triplet plus bevacizumab. A previous pooled analysis of TRIBE and TRIBE2 studies showed that elderly patients (i.e., those >70 years old) have a higher risk of experiencing severe toxicity with this intensified regimen [24]. Of note, granulocyte colony-stimulating factor was not recommended as primary prophylaxis in trials investigating FOLFOXIRI-bevacizumab, considering the relatively low overall rate of febrile neutropenia (6%) [25].…”

Section: Discussionmentioning

confidence: 99%

FOLFOXIRI-Bevacizumab or FOLFOX-Panitumumab in Patients with Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer: A Propensity Score-Based Analysis

et al. 2021

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Background Doublets plus anti‐epidermal growth factor receptors (EGFRs) are the preferred upfront option for patients with left‐sided RAS/BRAF wild‐type metastatic colorectal cancer (mCRC). Initial therapy with FOLFOXIRI‐bevacizumab is superior to doublets plus bevacizumab independently from primary tumor sidedness and RAS/BRAF status. No randomized comparison between FOLFOXIRI‐bevacizumab versus doublets plus anti‐EGFRs is available in left‐sided RAS/BRAF wild‐type mCRC. Materials and Methods We selected patients with left‐sided RAS and BRAF wild‐type mCRC treated with first‐line FOLFOX‐panitumumab or FOLFOXIRI‐bevacizumab in five randomized trials: Valentino, TRIBE, TRIBE2, STEAM, and CHARTA. A propensity score‐based analysis was performed to compare FOLFOXIRI‐bevacizumab with FOLFOX‐panitumumab. Results A total of 185 patients received FOLFOX‐panitumumab and 132 received FOLFOXIRI‐bevacizumab. Median progression‐free survival (PFS) and median overall survival (OS) were 13.3 and 33.1 months in the FOLFOXIRI‐bevacizumab group compared with 11.4 and 30.3 months in the FOLFOX‐panitumumab group (propensity score‐adjusted hazard ratio (HR) for PFS, 0.82; 95% confidence interval (CI), 0.64–1.04; p = .11; propensity score‐adjusted HR for OS, 0.80; 95% CI, 0.59–1.08; p = .14). No significant differences in overall response rate and disease control rate were observed. A statistically nonsignificant difference in favor of FOLFOXIRI‐bevacizumab was observed for OS after secondary resection of metastases. Chemotherapy‐related adverse events were more frequent in the FOLFOXIRI‐bevacizumab group, with specific regard to grade 3 and 4 neutropenia (48% vs. 26%, adjusted p = .001). Conclusion Although randomized comparison is lacking, both FOLFOXIRI‐bevacizumab and FOLFOX‐panitumumab are valuable treatment options in left‐sided RAS/BRAF wild‐type mCRC. Implications for Practice A propensity score‐based analysis of five trials was performed to compare FOLFOX‐panitumumab versus FOLFOXIRI‐bevacizumab in left‐sided RAS/BRAF wild‐type metastatic colorectal cancer (mCRC). No significant differences were observed, but FOLFOXIRI‐bevacizumab achieved numerically superior survival outcomes versus FOLFOX‐panitumumab. Chemotherapy‐related adverse events were more frequent in the FOLFOXIRI‐bevacizumab group. These observations suggest that although doublet chemotherapy plus anti‐EGFRs remains the preferred treatment in patients with left‐sided RAS/BRAF wild‐type mCRC, FOLFOXIRI‐bevacizumab is a valuable option able to provide similar, if not better, outcomes at the price of a moderate increase in toxicity and may be adopted based on patients’ preference and potential impact on quality of life.

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Section: Discussionmentioning

confidence: 99%

FOLFOXIRI-Bevacizumab or FOLFOX-Panitumumab in Patients with Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer: A Propensity Score-Based Analysis

et al. 2021

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“…Because in patients aged 70 to 75 years the risk of grade 3 and 4 diarrhea and neutropenia is increased, we carefully weighted the use of the triplet in this age subgroup. 48 To minimize the risk of neutropenia, the use of granulocyte-colony stimulating factor (G-CSF) as primary prophylaxis, which is not routinely recommended, was considered, as well as modified schedules of FOLFOXIRI, with reduced doses of 5fluorouracil (2400 mg/m 2 instead of 3200 mg/m 2 ) and irinotecan (150 mg/m 2 instead of 165 mg/m 2 ). 46…”

Section: Colorectal Cancermentioning

confidence: 99%

Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

Pietrantonio

Morano

Niger

et al. 2020

Clinical Colorectal Cancer

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The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak poses a major challenge in the treatment decision-making of patients with cancer, who may be at higher risk of developing a severe and deadly SARS-CoV-2 infection compared with the general population. The health care emergency is forcing the reshaping of the daily assessment between risks and benefits expected from the administration of immune-suppressive and potentially toxic treatments.To guide our clinical decisions at the National Cancer Institute of Milan (Lombardy region, the epicenter of the outbreak in Italy), we formulated Coronavirus-adapted institutional recommendations for the systemic treatment of patients with gastrointestinal cancers. Here, we describe how our daily clinical practice has changed due to the pandemic outbreak, with the aim of providing useful suggestions for physicians that are facing the same challenges worldwide.

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“…Тем более что в неблагоприятной эпидемической ситуации границы для назначения ГКСФ с целью первичной профилактики фебрильной нейтропении были сдвинуты, и теперь, даже если режим вызывает разви тие фебрильных нейтропений у 10-20% больных, их нужно назначать даже без отсутствия факторов риска [62]. Однако при назначении режима FOLFOXIRI следует помнить, что его применение у пациентов старше 70 лет в 84% случаев было ассоциировано с развитием токсичности 3-4-й степени [63]. Поэтому в настоящих условиях лучше воздержаться от назначения интенсивных схем у пациентов старшей возрастной группы.…”

Section: метастатический рак толстой кишкиunclassified

Practical recommendation for treatment of patients with colon cancer during covid-19 pandemic

Fedyanin

2020

Medicinskij sovet

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Restrictions on the cancer care in an epidemic are observed in the most countries of the world. The first small publications gave information of the increased susceptibility of cancer patients to a new infection which led to the postpone of elective surgery, initiation of adjuvant therapy, and the transfer of specialist consultations to telemedicine. The cases of infections of medical personnel, as well as the reassignment of clinical units and clinics that previously assisted cancer patients to the treatment of patients with COVID-19, also contributed. This article presents the experience of treating viral infections in cancer patients from different countries. On the example of colon cancer, treatment approaches are considered that, in conditions of increased epidemic danger, will allow our patients to provide effective antitumor treatment. We recommend to use short course of radiotherapy with chemotherapy in patients with locally-advanced rectal tumors; short course of adjuvant chemotherapy in stage 3 colon cancer; rational decisions for choosing regimen in 1st and subsequent lines of systemic therapy in patients with metastatic disease.

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Impact of age and gender on the safety and efficacy of chemotherapy plus bevacizumab in metastatic colorectal cancer: a pooled analysis of TRIBE and TRIBE2 studies

Cited by 28 publications

References 13 publications

FOLFOXIRI-Bevacizumab or FOLFOX-Panitumumab in Patients with Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer: A Propensity Score-Based Analysis

FOLFOXIRI-Bevacizumab or FOLFOX-Panitumumab in Patients with Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer: A Propensity Score-Based Analysis

Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

Practical recommendation for treatment of patients with colon cancer during covid-19 pandemic

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