FOLFIRI plus aflibercept in the treatment of metastatic colorectal cancer outside of clinical trials

This study investigated the effectiveness of the combined treatment FOLFIRI with aflibercept (Zaltrap) outside of clinical trials in patients with metastatic (spread to other parts of the body) colorectal cancer (mCRC). Researchers suggested that this treatment might be a safe second line option in patients who progressed after first-line treatment.

CRC is the second most common cancer in Europe. The standard first-line chemotherapy is a combination of fluorouracil, leucovorin and either oxaliplatin (FOLFOX) or irinotecan (FOLFIRI). Chemotherapy is a combination of different drugs that attack and kill cancer cells. However, chemotherapy has a limited effect depending on the type and stage of the tumor.

Therefore, most patients today are also treated with biological agents such as aflibercept. This agent stops the tumor from growing. Therefore, this treatment may improve the effect of chemotherapy. Prior studies showed that this agent improves the overall survival of patients with mCRC. However, these clinical trials included only selected patients.

It is still unclear how beneficial is FOLFIRI plus aflibercept in patients with mCRC who progressed after first-line treatment in the real world (outside of clinical trials).

This study included information about 78 patients with mCRC who progressed after initial treatment. These patients received aflibercept on day 1 every 2 weeks, followed by FOLFIRI. They were followed-up for an average of 11.5 months.

The tumor response rate was 70.5%. At follow-up, survival without cancer worsening was 6.8 months. Overall survival was 12 months. Thee were similar to previous clinical trials.

The most common moderate side effects were neutropenia (loss of immune cells; 15.3%), weakness (10.3%) and diarrhea (6.4 %). Patients with hypertension (high blood pressure) had a 2.7-fold improvement in the odds of a lower risk of progression. 

This study concluded that FOLFIRI plus aflibercept had similar effectiveness in the real world as in clinical trials. The authors suggested that this treatment might be a safe second-line option in patients who progressed after first-line treatment.