Angiogenesis Inhibitors in mCRC

S. Gail Eckhardt, MD, professor and head of the Division of Medical Oncology at the University of Colorado Denver and Health Sciences Center, discusses the role of angiogenesis inhibitors for the treatment of metastatic colorectal cancer (mCRC), following the approval of aflibercept.

Eckhardt notes that she has not administered aflibercept, not because of bias, but rather due to a lack of a formal comparison to bevacizumab. Both agents possess a unique toxicity profile in addition to the toxicity associated with the chemotherapy that is co-administered, Eckhardt notes. As such, new side effect management techniques would be required in this space.

Without a formal comparison to bevacizumab, Eckhardt remains unsure where to position aflibercept in the treatment sequence for patients with mCRC. There is evidence that bevacizumab works beyond progression, Eckhardt notes, but it remains unclear if aflibercept possesses these same properties. However, clinical trials have shown that aflibercept is effective following bevacizumab and may be an ideal choice as a second-line treatment.

There are data suggesting that agents inhibiting angiogenesis can be moved around in the sequence during the treatment of renal cell carcinoma, Eckhardt points out. However, this approach has not been examined for patients with colorectal cancer.

Clinical Pearls

• A formal comparison between aflibercept and bevacizumab is lacking, leaving physicians unsure where to position aflibercept in the treatment sequence for patients with mCRC
• There is evidence that bevacizumab works beyond progression, but it remains unclear if aflibercept possesses these same properties
• Clinical trials have shown that aflibercept is effective following bevacizumab and may be an ideal choice as a second-line treatment