title: Bevacizumab plus chemotherapy as third- or later-line therapy in patients with heavily treated metastatic colorectal cancer.
abstract: BACKGROUND
  Currently available third- or later-line therapy for metastatic colorectal cancer (mCRC) is limited in its efficacy, with a weak survival benefit in patients who progressed after two or more lines of standard therapy. Our retrospective study aimed to explore the value of bevacizumab plus chemotherapy in this setting.
  
  
  METHODS
  Patients with mCRC who received fluoropyrimidine, oxaliplatin, and irinotecan as first- and second-line chemotherapy were selected for inclusion. Treatment consisted of bevacizumab plus chemotherapy. Chemotherapy consisted mainly of oxaliplatin, irinotecan, and fluoropyrimidine.
  
  
  RESULTS
  Between February 2010 and December 2012, 35 consecutive patients with mCRC were treated with bevacizumab plus chemotherapy as a third- or later-line treatment. No complete responses, seven partial responses (20%), 22 stable disease responses (62.9%), and six progressive disease responses (17.1%) were obtained, producing an objective response rate of 20% and a disease control rate of 82.9%. With a median follow-up of 11.3 months (range: 0.7-48.0 months), the median progression-free survival was 5.98 months (95% confidence interval: 4.76-7.2 months), and the median overall survival was 14.77 months (95% confidence interval: 11.45-18.1 months). In the univariate analysis, patients with a primary colon tumor might have had a longer overall survival than patients with a primary rectal tumor (18.8 months vs 11.1 months, respectively; P=0.037). Common chemotherapy-related toxicities were nausea/vomiting (48.6%), fatigue (34.3%), leucopenia (40%), neutropenia, (42.9%), and anemia (42.9%), with one patient with grade 3 neutropenia, and two patients with grade 3 thrombocytopenia. The common bevacizumab-associated toxicity was hypertension (31.4%). None of the patients discontinued therapy or died because of bevacizumab-associated toxicities.
  
  
  CONCLUSIONS
  Our data showed that adding bevacizumab to third- or later-line therapy might lead to tumor control and improved survival in heavily pretreated mCRC patients. In addition, preliminary data suggested that primary colon cancer was more likely to benefit from bevacizumab-containing regimens. Toxicities were acceptable, and no new toxicity was identified. Further studies are needed to validate these findings.
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Yang
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Chenxi
authors.initials: C
authors.lastname: Yin
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Fangxin
authors.initials: F
authors.lastname: Liao
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Huang
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Wenzhuo
authors.initials: W
authors.lastname: He
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Chang
authors.initials: C
authors.lastname: Jiang
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Guifang
authors.initials: G
authors.lastname: Guo
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Bei
authors.initials: B
authors.lastname: Zhang
authors.affiliation: VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Liangping
authors.initials: L
authors.lastname: Xia
keywords: bevacizumab; chemotherapy; metastatic colorectal cancer