Oncology, Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem
Introduction: Bevacizumab (BVC), a monoclonal antibody directed against vascular endothelial growth factor, provides a significant survival advantage when added to first-line CTX for metastatic colon cancer. Several mechanisms of action have been proposed to explain this beneficial additive effect to CTX. It is currently not clear whether following failure of the initial treatment containing BVC second line therapy should also contain this drug. Here we report our experience with the use of BVC in combination with second line CTX in metastatic colon cancer. Patients / Methods: From 4/2009 to 10/2011 sixty two patients were prospectively treated by second line CTX concurrently with BVC 5 mg/kg. The median age at diagnosis was 65 years (range 38-82) with male/female ratio of 34/28. Sixty one patient were tested for KRAS status, there were 59% with mutated KRAS and 41% with wild type. First line CTX consisted of BVC combined with Folfox (36 pts-58%); Folfiri (14 pts-22.6%); and with 5FU-LCV (12 pts- 19.3% ). Second line treatment consisted of BVC combined with Folfox (15 pts-24.2%); Folfiri (42 pts-67.7%); and 5FU-LCV (5 pts-8%). The primary end point was overall survival (OS); secondary endpoints included progression-free survival (PFS), response rate and safety Results: The overall response rate was 16.1 % (CR 3.2% and 12.9% PR) and disease stabilization ( over 12 weeks) in 58.1% with a clinical benefit in 74.2% . Median time to progression was 5.96 months .Median Overall Survival was 15 months. Overall Survival for patient with wild type KRAS was 18 months and for patient with mutated KRAS was 13 months (p=0.02). Therapy was well tolerated without any grade 3/4 complications. Patient with long response duration in first-line chemotherapy had significantly long response duration also in the second- line chemotherapy. Conclusions: Our findings demonstrate that Continuation of BVC with second line therapy in colon cancer is feasible and well tolerated and should be considerate for patient with long response duration in first-line chemotherapy
