571P - Bevacizumab (BEV) + chemotherapy (CT) beyond first progression in patients (pts) with metastatic colorectal cancer (mCRC) previously treated with fi...

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Anticancer agents
Colon and Rectal Cancer
Biological Therapy
Presenter Pia Osterlund
Authors P.J. Osterlund1, V. Alonso-Orduna2, C. Schlichting3, T. André4, J. Sastre5, R. Greil6, S. Kubicka7, I. Reyes-Rivera8, B. McCall9, E. Van Cutsem10
  • 1Medical Oncology, Helsinki University Central Hospital, Helsinki/FI
  • 2Servicio De Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza/ES
  • 3I. Chirurgische Klinik, Diakoniekrankenhaus Rotenburg GmbH, Rotenburg/DE
  • 4Medical Oncology, Hopital Saint-Antoine and Université Pierre et Marie Curie, FR-75012 - Paris/FR
  • 5Medical Oncology, Servicio de Oncología Médica HC, Madrid/ES
  • 6Oncology Centre, III Medizinische Universitätsklinik Salzburg, Salzburg/AT
  • 7Department Of Internal Medicine I, Gastroenterology, Cancer Center Reutlingen, Reutlingen/DE
  • 8Statistics, Genentech Inc., South San Francisco/US
  • 9Product Development, Oncology, Genentech, Inc., 94080 - South San Francisco/US
  • 10Digestive Oncology, University Hospital Gasthuisberg, Leuven/BE



ML18147 is the first randomised study to show that continuing BEV + standard CT as second-line (2L) treatment significantly improves overall survival (OS) and progression-free survival (PFS) in pts with mCRC who progressed after receiving a standard first-line (1L) BEV-containing regimen. Here we evaluate outcome in the 2L setting using, as a stratification factor, 1L oxaliplatin vs irinotecan-based CT.


Pts with unresectable, histologically confirmed mCRC who progressed within 3 months of discontinuing 1L BEV were randomised to 2L fluoropyrimidine-based CT ± BEV (2.5 mg/kg/wk equivalent). Choice of 2L oxaliplatin or irinotecan was dependent on the 1L regimen (crossover). OS, PFS, overall response rate (ORR) and adverse events (AEs) were analysed in the 2L setting using the 1L oxaliplatin or irinotecan-based CT as a stratification factor.


820 pts were randomised from Feb 2006 to Jun 2010. Of these, 343 received 1L oxaliplatin-based CT and 476 received 1L irinotecan-based CT, after which they crossed over to receive either oxaliplatin or irinotecan-based CT in 2L. BEV + CT beyond progression prolonged OS and PFS, regardless of whether oxaliplatin or irinotecan-based CT was used in 1L (Table). ORR was low in CT and BEV + CT-treated pts in both groups. AEs associated with BEV were generally similar in pts treated with either oxaliplatin or irinotecan-based CT.

1L oxaliplatin-based CT 1L irinotecan-based CT
Outcome in 2L CT (n = 174) BEV + CT (n = 169) CT (n = 236) BEV + CT (n = 240)
Median OS, months 10.0 12.0 9.3 10.9
p-value 0.0524 0.0454
HR (95% CI) 0.79 (0.62–1.00) 0.82 (0.67–1.00)
Median PFS, months 4.2 6.2 3.8 5.4
p-value 0.0005 <0.0001
HR (95% CI) 0.68 (0.55–0.85) 0.67 (0.56–0.81)
ORR, % 2.9 5.5 4.7 5.4
p-value 0.2414 0.7145
Grade 3–5 AEs in >1% of pts, %
Any 52 66 60 61
Hypertension 0 1 2 2
Bleeding/haemorrhage <1 3 0 1
GI perforation <1 2 <1 1
Venous thromboembolic event 5 7 1 3


This post-hoc subgroup analysis suggests that continuing BEV + 2L oxaliplatin or irinotecan-based CT (following crossover) leads to prolonged OS and PFS, regardless of the type of oxaliplatin or irinotecan-based CT used 1L.


P. Österlund: Consultant / advisory board: Roche Honoraria: Roche.

T. André: Consultant / advisory board: Roche.

J. Sastre: Honoraria: Roche Research funding: Roche.

R. Greil: Honoraria: Roche Research support: Roche.

S. Kubicka: Consultant / advisory board: Roche. Honoraria: Roche.

I. Reyes-Rivera: Employed by Genentech Inc.

B. McCall: Employed by Genentech Inc.

E.J.D. Van Cutsem: Research funding: Roche.

All other authors have declared no conflicts of interest.