Stop and go FOLFOX plus bevacizumab chemotherapy in the first-line treatment of metastatic colorectal cancer.
BACKGROUND
Infusional 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX) plus bevacizumab chemotherapy is commonly implemented in the first-line treatment of metastatic colorectal cancer. A stop and go oxaliplatin strategy has been recommended to reduce oxaliplatin-associated neuropathy. Despite the acceptance of this strategy by community and academic practices, efficacy data with this approach are limited.


METHODS
We analyzed the efficacy of a stop and go FOLFOX regimen combined with bevacizumab in a single institute between January 2007 and December 2009. Oxaliplatin was withdrawn electively after 8 cycles of treatment and patients were maintained on 5-fluorouracil/leucovorin and bevacizumab until progression. When feasible, patients were rechallenged with oxaliplatin upon progression.


RESULTS
Sixty-seven patients were treated and analyzed for outcome. The response rate of this group was 58%. The median progression-free and overall survival was 10.6 and 26.7 months, respectively. The median duration of disease control in the 18-patient subgroup that was rechallenged with oxaliplatin was 21.2 months.


CONCLUSIONS
Elective withdrawal of oxaliplatin after 8 cycles in the setting of FOLFOX and bevacizumab does not appear to compromise the activity of this regimen. A stop and go approach of FOLFOX plus bevacizumab is effective and may reduce treatment costs and toxicity in comparison with a continuous FOLFOX treatment strategy.
Department of Internal Medicine, University at Buffalo, Buffalo, NY 14263, USA.
Gayatri
G
Vaidyanathan
Adrienne
A
Groman
Gregory
G
Wilding
Marwan G
MG
Fakih
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil