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Originally published as JCO Early Release 10.1200/JCO.2005.05.112 on February 28 2005

Journal of Clinical Oncology, Vol 23, No 16 (June 1), 2005: pp. 3697-3705
© 2005 American Society of Clinical Oncology.

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Addition of Bevacizumab to Bolus Fluorouracil and Leucovorin in First-Line Metastatic Colorectal Cancer: Results of a Randomized Phase II Trial

Fairooz F. Kabbinavar, Joseph Schulz, Michael McCleod, Taral Patel, John T. Hamm, J. Randolph Hecht, Robert Mass, Brent Perrou, Betty Nelson, William F. Novotny

From the University of California, Los Angeles (UCLA) School of Medicine, Los Angeles; Genentech Inc, South San Francisco, CA; Virginia Oncology Associates, Newport News, VA; Florida Cancer Specialists, Ft Myers, FL; Mid Ohio Oncology Hematology Inc, Westerville, OH; Louisville Oncology, Louisville, KY

Address reprint requests to Fairooz F. Kabbinavar, MD, Division of Hematology/Oncology, UCLA School of Medicine, 10945 LeConte Ave, Suite 2338J, Los Angeles, CA 90095-7187; e-mail: fkabbina{at}mednet.ucla.edu

PURPOSE: Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, increases survival when combined with irinotecan-based chemotherapy in first-line treatment of metastatic colorectal cancer (CRC). This randomized, phase II trial compared bevacizumab plus fluorouracil and leucovorin (FU/LV) versus placebo plus FU/LV as first-line therapy in patients considered nonoptimal candidates for first-line irinotecan.

PATIENTS AND METHODS: Patients had metastatic CRC and one of the following characteristics: age ≥ 65 years, Eastern Cooperative Oncology Group performance status 1 or 2, serum albumin ≤ 3.5 g/dL, or prior abdominal/pelvic radiotherapy. Patients were randomly assigned to FU/LV/placebo (n = 105) or FU/LV/bevacizumab (n = 104). The primary end point was overall survival. Secondary end points were progression-free survival, response rate, response duration, and quality of life. Safety was also assessed.

RESULTS: Median survival was 16.6 months for the FU/LV/bevacizumab group and 12.9 months for the FU/LV/placebo group (hazard ratio, 0.79; P = .16). Median progression-free survival was 9.2 months (FU/LV/bevacizumab) and 5.5 months (FU/LV/placebo); hazard ratio was 0.50; P = .0002. Response rates were 26.0% (FU/LV/bevacizumab) and 15.2% (FU/LV/placebo) (P = .055); duration of response was 9.2 months (FU/LV/bevacizumab) and 6.8 months (FU/LV/placebo); hazard ratio was 0.42; P = .088. Grade 3 hypertension was more common with bevacizumab treatment (16% v 3%) but was controlled with oral medication and did not cause study drug discontinuation.

CONCLUSION: Addition of bevacizumab to FU/LV as first-line therapy in CRC patients who were not considered optimal candidates for first-line irinotecan treatment provided clinically significant patient benefit, including statistically significant improvement in progression-free survival.

Supported by Genentech Inc.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.


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