Abstract 435P
Background
The continuation of angiogenesis inhibition increases survival compared to FOLFIRI alone after failure of L1 for mCRC but no study has evaluated the direct comparison between bev continuation and the switch to afli.
Methods
In this French retrospective multicentre cohort, we included patients with mCRC treated with either FOLFIRI-afli or FOLFIRI-bev at the oncologist’s discretion after progression on L1. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival (PFS), disease control rate (DCR: CR+PR+SD) and safety. We also analysed PFS in a subgroup of primary bev-resistant patients (L1 PFS<3 months).
Results
A total of 346 patients from 17 centres were included: 165 in the afli group and 181 in the bev group. No significant difference in patient characteristics was observed (including for L1 PFS < 3 months). Median age was 63.5 years and 53.8% of patients were men. Most patients had RAS-mutated tumours (76.3%), synchronous metastatic disease (87%), and an ECOG performance status (PS) 0-1 (82.4%). After a median follow up of 27.3 months, median OS was 13.8 months (95%CI: 11.2-15.4) and 9.7 months (95%CI: 7.7-11.9) in the bev and afli groups, respectively (P<0.0001). Median PFS was 5.5 months and 4.7 months, respectively (P<0.01). DCR in the bev and afli groups were 72.7% and 61.8% (P=0.04). After adjustment for age, PS, CEA level, L1 PFS, primary tumour resection, metastases location and RAS/BRAF status, bev was associated with better OS (HR: 0.67, 95%CI: 0.49-0.92, P=0.01) and PFS (HR: 0.70, 95%CI: 0.54-0.90, P=0.005). In the primary bev-resistant group, no difference was observed between bev and afli: OS (median: 8.0 vs 9.3 months, P=0.3) and PFS (median: 6.5 vs 5.0 months, P=0.4). Grade 3-4 toxicities were more frequent in the afli group: asthenia (24.8% vs 12.7%, P=0.004), diarrhoea (16.4% vs 6%, P=0.002), and hypertension (9.7% vs 3.9%, P=0.03).
Conclusions
In this large multicentre retrospective cohort, FOLFIRI-bev was associated with longer PFS and OS as compared to FOLFIRI-afli in patients with mCRC in L2 after progression on FOLFOX-bev. A prospective study is warranted to confirm these results.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Cecile Torregrosa.
Funding
Has not received any funding.
Disclosure
S. Pernot: Honoraria (self): Amgen; Honoraria (self): Merck; Honoraria (self): Pierre Fabre; Honoraria (self): Sanofi; Honoraria (self): Servier. O. Dubreuil: Travel/Accommodation/Expenses: Sanofi; Travel/Accommodation/Expenses: Roche. A. Turpin: Honoraria (self): Amgen; Honoraria (self): Merck; Honoraria (self): Servier; Honoraria (self): Mylan; Travel/Accommodation/Expenses: AstraZeneca; Travel/Accommodation/Expenses: Pfizer; Travel/Accommodation/Expenses: Sanofi. L-J. Palmieri: Honoraria (self): Amgen; Honoraria (self): Merck; Honoraria (self): Servier; Honoraria (self): Keocyt. O. Bouche: Honoraria (self): Merck KGaA; Honoraria (self): Pierre Fabre; Honoraria (self): Servier; Honoraria (self): Amgen; Honoraria (self): MSD; Honoraria (self): Grunenthal; Honoraria (self): AstraZeneca; Honoraria (self): Bayer; Honoraria (self): Roche Genentech. D. Sefrioui: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen; Honoraria (self), Travel/Accommodation/Expenses: Amgen; Advisory/Consultancy, Travel/Accommodation/Expenses: Servier; Travel/Accommodation/Expenses: Novartis; Travel/Accommodation/Expenses: Pfizer; Travel/Accommodation/Expenses: Sandoz; Travel/Accommodation/Expenses: Pierre Fabre. C. Locher: Travel/Accommodation/Expenses: Roche; Travel/Accommodation/Expenses: Amgen; Travel/Accommodation/Expenses: Ipsen; Honoraria (self): Merck; Honoraria (self): Novartis. C. Lecaille: Honoraria (self), Travel/Accommodation/Expenses: Sanofi; Honoraria (self), Travel/Accommodation/Expenses: Roche. J. Taieb: Advisory/Consultancy: Roche; Advisory/Consultancy: Genetech; Advisory/Consultancy: Lilly; Advisory/Consultancy: Servier; Advisory/Consultancy: Sanofi; Advisory/Consultancy: Celgene; Advisory/Consultancy: Shire; Advisory/Consultancy: Amgen; Advisory/Consultancy: Sirtex; Advisory/Consultancy: Merck; Advisory/Consultancy: MSD. E. Auclin: Honoraria (self): Sanofi; Honoraria (self): Genzymes. All other authors have declared no conflicts of interest.