FOLFOXIRI Plus Bevacizumab Use Increased From 2013 to 2022 in Younger Patients With mCRC
From 2013 to 2022, the use of FOLFOXIRI plus bevacizumab increased in patients with metastatic colorectal cancer, with a trend in patients aged 50 years and younger.
Stomach and intestine with organs anterior view: © 7activestudio - stock.adobe.com
The use of FOLFOXIRI plus bevacizumab (Avastin; triplet+bev) increased from 2013 to 2022 in patients with metastatic colorectal cancer (mCRC), specifically in patients younger than 50 years old, according to findings from a retrospective study presented at the 2024 ASCO Gastrointestinal Cancers Symposium.
Results also demonstrated that the most frequent subsequent therapies following first- and second-line triplet+bev included anti-epidermal growth factor receptor (EGFR) therapies, trifluridine/tipiracil (Lonsurf), and regorafenib (Stivarga).
“This real-world study of patients with mCRC in the US revealed that first- and any-line triplet+bev usage has increased over time, particularly in younger patients,” the researchers wrote in the poster.
From 2013 to 2022, the use of triplet+bev increased in newly treated patients, with a trend being more pronounced in patients aged 18 to 49 years.
In patients not censored before the end of the respective line of therapy, the median duration of first-line triplet+bev was 25.1 weeks and 21.6 weeks for second-line use of the regimen. The median duration of triplet+bev in patients who were not censored, with and without a KRAS mutation, was 26.1 weeks and 23.5 weeks in the first-line setting, respectively. For second-line use of the regimen, the median duration was 21.6 weeks in patients with a KRAS mutation and 16.5 weeks for those without the specific mutation.
After first-line triplet+bev, the most frequently used new agents included anti-EGFR therapies like cetuximab (Erbitux) and panitumumab (Vectibix; 19%), trifluridine/tipiracil (12%) regorafenib (10%), and capecitabine (Xeloda; 3%). In the second-line setting, the most frequently used new agents were trifluridine/tipiracil (21%), anti-EGFR therapies (17%), regorafenib (15%), and pembrolizumab (Keytruda).
“This may suggest a role for noncytotoxic chemotherapy treatments, including EGFR inhibitors and regorafenib, beyond the first-line setting, which may be used to avoid further chemotherapy-related toxicities such as neutropenia, nausea, and diarrhea,” the study authors wrote.
In this retrospective study, researchers used the nationwide deidentified Flatiron Health Electronic Health Record-derived database with information from January 1, 2013, to February 28, 2023. In particular, the use of triplet+bev and treatments following that regimen was assessed in patients aged 18 years and older with newly diagnosed mCRC by age (18-49, 50-64, and ≥65 years) and oncologist-defined, rule-based line of treatment. Of the 24,285 patients in this study, 38% of patients were aged 18 to 49 years, 44% were between the ages of 50 and 64, and 19% were 65 years and older at the index date.
“Evidence suggests that patients with early-onset mCRC are more likely to receive aggressive multiagent chemotherapy, including triplet+bev, compared to patients with late-onset disease,” the study authors wrote. “Nevertheless, clinical treatment guidelines do not recommend different treatments by age group. Contemporary evidence is needed regarding the use of triplet+bev and subsequent systemic treatments, across different age groups in patients with mCRC, to tailor appropriate follow-up treatment options in this patient group.”
When starting treatment, 35% were aged 18 to 49 years, 29% were between the ages of 50 and 64 years, and 14% were aged 65 years and older when starting treatment. The use of triplet+bev in any line of treatment was the most prevalent in patients aged 18 to 49 years (7%), followed by patients aged 50 to 64 years (3%) and those 65 years and older (1%). Two-thirds of the patient population (67%) received triplet+bev in the first-line setting, whereas 23% received the regimen in the second-line setting. In addition, 57% were men and 34% of patients had a KRAS mutation, with 23% missing.
