Second-line chemotherapy after early disease progression during first-line chemotherapy containing bevacizumab for patients with metastatic colorectal cancer

• Published in: BMC cancer Vol. 21; no. 1; pp. 1159 - 9
• Main Authors: Yamamoto, Shun, Nagashima, Kengo, Kawakami, Takeshi, Mitani, Seiichiro, Komoda, Masato, Tsuji, Yasushi, Izawa, Naoki, Kawakami, Kentaro, Yamamoto, Yoshiyuki, Makiyama, Akitaka, Yamazaki, Kentaro, Masuishi, Toshiki, Esaki, Taito, Nakajima, Takako Eguchi, Okuda, Hiroyuki, Moriwaki, Toshikazu, Boku, Narikazu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.10.2021; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Angiogenesis; Angiogenesis Inhibitors - therapeutic use; Antiangiogenic agents; Antibodies; Antineoplastic Agents, Immunological - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Bevacizumab - therapeutic use; Bevacizumab continuation beyond progression; Camptothecin - analogs & derivatives; Camptothecin - therapeutic use; Cancer; Chemotherapy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Confidence intervals; Cytotoxicity; Disease control; Disease Progression; Drug Administration Schedule; Drug therapy; Early disease progression; Female; Fluorouracil - therapeutic use; Humans; Irinotecan - therapeutic use; Japan; Leucovorin - therapeutic use; Male; Medical prognosis; Metastases; Metastasis; Metastatic colorectal cancer; Middle Aged; Monoclonal antibodies; Multivariate analysis; Neutropenia; Organoplatinum Compounds - therapeutic use; Oxaliplatin - therapeutic use; Patient outcomes; Patients; Progression-Free Survival; Pyrimidines - therapeutic use; Retrospective Studies; Second-line chemotherapy; Survival; Targeted cancer therapy; Time Factors; Japan; Second-line chemotherapy; Early disease progression; Metastatic colorectal cancer; Bevacizumab continuation beyond progression
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08890-6

The ML18174 study, which showed benefits of bevacizumab (BEV) continuation beyond progression (BBP) for metastatic colorectal cancer (mCRC), excluded patients with first-line progression-free survival (PFS) shorter than 3 months. The present study was conducted to evaluate the efficacy of second-line chemotherapy after early disease progression during first-line chemotherapy containing bevacizumab. The subjects of this study were mCRC patients who experienced disease progression < 100 days from commencement of first-line chemotherapy containing BEV initiated between Apr 2007 and Dec 2016. Second-line chemotherapy regimens were classified into two groups with and without BEV/other anti-angiogenic agents (BBP and non-BBP) and efficacy and safety were compared using univariate and multivariate analysis. Sixty-one patients were identified as subjects of this study. Baseline characteristics were numerically different between BBP (n = 37) and non-BBP (n = 25) groups, such as performance status (0-1/> 2/unknown: 89/8/3 and 56/40/4%), RAS status (wild/mutant/unknown: 32/54/16 and 76/16/8%). Response rate was 8.6% in BBP group and 9.1% in non-BBP group (p = 1.00). Median PFS was 3.9 months in BBP group and 2.8 months in non-BBP group (HR [95%CI]: 0.79 [0.46-1.34], p = 0.373, adjusted HR: 0.87 [0.41-1.82], p = 0.707). Median overall survival was 8.5 months in BBP group and 5.4 months in non-BBP group (HR 0.66 [0.38-1.12], p = 0.125, adjusted HR 0.53 [0.27-1.07], p = 0.078). In mCRC patients who experienced early progression in first-line chemotherapy, second-line chemotherapy showed poor clinical outcomes regardless use of anti-angiogenic agents.