Sequential Treatment with Bevacizumab and Aflibercept for Metastatic Colorectal Cancer in Real-World Clinical Practice

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Authors	BUCHLER Tomas KISS Igor HORNOVA Jana FIALA Ondrej WIESNEROVA Marketa SVOBODA Michal SILAR Jiri KOPECKOVA Katerina POPRACH Alexandr FINEK Jindrich PETRUZELKA Lubos MELICHAR Bohuslav
Year of publication	2020
Type	Article in Periodical
Magazine / Source	Targeted Oncology
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://link.springer.com/article/10.1007%2Fs11523-020-00705-1
Doi	http://dx.doi.org/10.1007/s11523-020-00705-1
Keywords	SIAN PATIENTS; SAFETY; FLUOROURACIL; COMBINATION; LEUCOVORIN; IRINOTECAN; EFFICACY
Description	Background Bevacizumab and aflibercept are currently the mainstay of antiangiogenic therapy for metastatic colorectal carcinoma (mCRC). They are often used in sequence with first- and second-line chemotherapy, especially in patients with RAS-mutated tumours. Objective The aim of the present study was to investigate the outcomes of patients with mCRC treated with the bevacizumab-aflibercept sequence in real-world clinical practice. Patients and Methods Data from a national clinical registry of targeted therapies for mCRC were analysed retrospectively. Overall, there were 366 patients with valid data who received first-line treatment with bevacizumab and chemotherapy followed by aflibercept with chemotherapy. The majority of the patients (n = 296, 80.8%) had RAS mutated tumours. Results Median cumulative progression-free survival (PFS) from the start of the bevacizumab-containing regimen to progression on aflibercept was 18.2 months (95% CI 16.8-19.5). Median PFS for bevacizumab and aflibercept was 10.6 months (95% CI 9.5-11.7) and 5.6 months (95% CI 5.1-6.1), respectively. Longer PFS on aflibercept was associated with metachronous metastatic disease and longer PFS on bevacizumab. Median overall survival (OS) from the start of first-line bevacizumab was 32.0 months (95% CI 26.6-37.5). The presence of metastatic disease at diagnosis was associated with worse OS. Conclusions Patients treated with aflibercept in real-world clinical practice achieved similar survival outcomes as those treated within randomised trials. Cumulative survival data provide a benchmark for future studies and enable indirect comparisons with other treatment sequences used in mCRC.