Xeloda and Avastin for maintenance in colon cancer – pro

History of maintenance in colon cancer is several years old. First, Avastin was approved for second line therapy in previously Avastin naive patients and this was followed by data analyses that suggested that Avastin with capecitabine is beneficial for maintenance. The newest study is by Lieke et al, who assigned 558 patients to either the maintenance group (n=279) or the observation group (n=279). Median follow-up was 48 months (IQR 36–57). The primary endpoint of median PFS2 was significantly improved in patients on maintenance treatment, and was 8·5 months in the observation group and 11·7 months in the maintenance group (HR 0·67, 95% CI 0·56–0·81, p<0·0001). This difference remained significant when any treatment after PFS1 was considered. Maintenance treatment was well tolerated, although the incidence of hand-foot syndrome was increased (64 [23%] patients with hand-foot skin reaction during maintenance). The global quality of life did not deteriorate during maintenance treatment and was clinically not different between treatment groups. The authors thought that it showed that maintenance treatment with capecitabine plus bevacizumab after six cycles of CAPOX-B in patients with metastatic colorectal cancer is effective and does not compromise quality of life.

Whether maintenance after irinotecan or EGFR based regimens is effective is not currently known as no studies of maintenance are available in these situations.

European Guideline says that maintenance treatment with a fluoropyrimidine alone prolongs the progression-free survival compared with a complete treatment break, after an initial period of combination chemotherapy [I, B]. NCCN does not mention it.

Koopman M, Lieke HJ, Simkens AJ, et al. Maintenance treatment with capecitabine and bevacizumab versus observation after induction treatment with chemotherapy and bevacizumab in metastatic colorectal cancer (mCRC): the phase III CAIRO3 study of the Dutch Colorectal Cancer Group (DCCG). J Clin Oncol. 2013;31(suppl):abstr 3502.

K.M. Galal, M. Abdelsalam, E.E. Fawzy, S. Mansour, K. Zaghloul and E.M. Mohamed Role of Bevacizumab as Post-Progression Maintenance Therapy in Metastatic Colon Cancer Journal of Medical Sciences Year: 2008 | Volume: 8 | Issue: 5 | Page No.: 452-460

Grothey, Axel, Sugrue, Mary M., Purdie, David M., Dong, Wei, Sargent, Daniel, Hedrick, Eric, Kozloff, Mark
Bevacizumab Beyond First Progression Is Associated With Prolonged Overall Survival in Metastatic Colorectal Cancer: Results From a Large Observational Cohort Study (BRiTE)
J Clin Oncol 2008 26: 5326-5334

S. Kopetz and J. L. Abbruzzese
Hidden Biases in an Observational Study of Bevacizumab Beyond Progression
J. Clin. Oncol., April 1, 2009; 27(10): 1732 – 1733.

L. M. Ellis and D. G. Haller
Bevacizumab Beyond Progression: Does This Make Sense?
J. Clin. Oncol., November 20, 2008; 26(33): 5313 – 5315.

Cohn AL, Bekaii-Saab T, Bendell JC, et al. Clinical outcomes in bevacizumab (BV)-treated patients (pts) with metastatic colorectal cancer (mCRC): results from ARIES observational cohort study (OCS) and confirmation of BRiTE data on BV beyond progression (BBP). J Clin Oncol 28(suppl 15):284s. ASCO Abstract #3596.

E. Van Cutsem et al, Advanced colorectal cancer: ESMO Clinical Practice Guidelines for treatment. Ann Oncol (2010) 21 (suppl 5): v93-v97

NCCN. Colon Cancer COL-6, 2016

Koopman M, Lieke HJ, Simkens AJ, et al. Maintenance treatment with capecitabine and bevacizumab versus observation after induction treatment with chemotherapy and bevacizumab in metastatic colorectal cancer (mCRC): the phase III CAIRO3 study of the Dutch Colorectal Cancer Group (DCCG). J Clin Oncol. 2013;31(suppl):abstr 3502.

Yang X, Weinberg B, Hwang JJ, et al. Survival analysis of maintenance therapy with capecitabine (Cape) in patients with resected pancreatic adenoma (PAC) after adjuvant therapy: a retrospective cohort study. J Clin Oncol. 2012;30(suppl):abstr e14658.

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