Over 70? Bevacizumab plus double chemotherapy treatment is safe and effective

This study examined the efficacy and safety of a combination of three drugs for treating elderly patients with metastatic colorectal cancer (cancer that has spread from the colon or rectum to distant sites). 

The combination of chemotherapy drugs capecitabine (Xeloda) and oxaliplatin (Eloxatin; XELOX) is safe and effective for treating patients with colorectal cancer. Bevacizumab (Avastin) blocks the formation of new blood vessels needed for the cancer to grow and spread. XELOX is often combined with bevacizumab to treat young patients with metastatic colorectal cancer.

Roughly 60% of colorectal cancer cases are diagnosed in patients 65 years or older. Despite this, older patients are often excluded from clinical trials. As a result it is unclear whether XELOX plus bevacizumab is safe and effective in older patients.

This study examined the safety and efficacy of XELOX plus bevacizumab in 48 elderly patients with metastatic colorectal cancer. All patients were treated with capecitabine (750 mg/m² twice a day during days 1–7), oxaliplatin (85 mg/m² on day 1) and bevacizumab (5 mg/kg on day 1). The treatment was repeated every 14 days. The disease control rate (indicating tumor shrinkage or stopped growth), progression free survival (time until the disease progresses) and overall survival (time until death from any cause) were assessed for each patient. The rate of adverse events was also assessed throughout the study. Patients were followed for an average of 15.6 months.

Disease control was seen in 74.4% of the patients. The average progression free survival was 7.9 months and the average overall survival was 20.1 months. After 1 year, 76.7% of patients were still alive, and 42.1% of patients were still alive after 2 years.

The most common severe adverse events were neutropenia (low levels of specific white blood cells needed to fight infection; 6.3% of patients), diarrhea (6.3% of patients), nausea (4.2% of patients), vomiting (4.2% of patients) and weakness (4.2% of patients).

The authors concluded that XELOX plus bevacizumab is an effective and safe combination for treating elderly patients with metastatic colorectal cancer.

This was a relatively small study, future work is need to ensure that the results are widely generalizable.