De-escalation Chemotherapies Versus Escalation in Non Pre-treated Unresectable Patients With Metastatic Colorectal Cancer
Status:
Terminated
Trial end date:
2020-10-01
Target enrollment:
Participant gender:
Summary
The intensity of tumour response appears to be correlated with the feasibility and the
duration of a therapeutic pause or of a reduced maintenance therapy maintained until
progression in patients initially controlled by so-called "induction" chemotherapy.
Bevacizumab combined with cytotoxic chemotherapy (5-FU, irinotecan and/or oxaliplatin) has
shown that it is possible to improve the tumour response rate and patient prognosis in 1st
and 2nd lines. With a very favourable safety profile , it is an excellent candidate as
induction treatment and also as maintenance treatment. Prospective data from recent trials
have actually demonstrated improvement in PFS and/or overall survival with bevacizumab
maintenance alone or in combination with 5FU (or capecitabine) after induction chemotherapy
(FOLFIRI or FOLFOX + bevacizumab).
At the same time, the maintenance of anti-angiogenic pressure after progression in 1st line
metastatic has demonstrated its benefit in terms of PFS and overall survival. Bevacizumab
maintenance in 2nd line metastatic, despite progression, thus appears to be a valid strategy.