Dr. Cremolini on Frontline FOLFOXIRI Plus Bevacizumab in mCRC

Chiara Cremolini, MD, a medical oncologist at the Tuscan Tumor Institute in Pisa, Italy, discusses findings from the phase III TRIBE trial that combined FOLFOXIRI with bevacizumab as a frontline treatment for patients with metastatic colorectal cancer (mCRC).

In the trial, bevacizumab plus FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan) demonstrated a median overall survival of 29.8 months compared with 25.8 months with FOLFIRI plus bevacizumab (HR = 0.80; P = .030). Furthermore, the median PFS was 12.3 months with FOLFOXIRI plus bevacizumab versus 9.7 months with FOLFIRI plus bevacizumab (HR = 0.77; P = .006).

One of the main concerns with the combination of the intensive chemotherapy FOLFOXIRI with bevacizumab was tolerability, explains Cremolini. To counter this, patients received treatment with the combination for 12 cycles over the course of 6 months followed by maintenance 5-FU and leucovorin plus bevacizumab until disease progression. Using this method, the combination was tolerable, Cremolini suggests.

A majority of side effects were observed during the induction period, with fewer adverse events occurring with maintenance therapy, notes Cremolini. During the induction period, FOLFOXIRI was associated with a higher incidence of grade 3/4 diarrhea, mucositis, neuropathy, and neutropenia compared with FOLFIRI.

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