Abstract
Purpose
To evaluate and compare the efficacy and safety of bevacizumab and aflibercept in second-line treatment in metastatic colorectal cancer (mCRC) in real-life clinical practice.
Methods
Retrospective observational study of patients treated with second-line bevacizumab (BFIR) and aflibercept (AFIR) in mCRC, associated with a FOLFIRI scheme, in the last 12 years (January 2009–January 2021) in a tertiary hospital. Patients with prior oxaliplatin-based treatment were included. Variables measured: previous chemotherapy, treatment time (TT), progression-free survival (PFS), overall survival (OS). To assess toxicity, adverse effects that caused delay in cycle administration were recorded. The lost cycles/month of treatment (CP/MT) were also calculated.
Results
Eighty-four patients [40 (47.6%) AFIR and 44 (52.4%) BFIR]. Average age: 60.2 ± 10.7 years. In 79.8% the previous scheme was FOLFOX type. Efficacy of AFIR vs BFIR: median HR of TT (95% CI) = 0.816 (0.527–1.266); p = 0.365, PFS HR (95% CI) = 0.674 (0.389–1.117); p = 0.159, OS HR (95% CI) = 0.566 (0.342–0.936); p = 0.026. The main reason for the delay in administration was neutropenia (28.7% AFIR vs 24.7% BFIR), and the greatest difference found was thrombopenia (13.9% AFIR vs 2.5% BFIR), without observing large differences between the rest of adverse reactions. Mean CP/MT: 0.49 ± 0.46 cycles with AFIR and 0.33 ± 0.27 with BFIR; p = 0.046.
Conclusion
Although no statistically significant differences have been found in TT or PFS, it would be more advisable to use BFIR scheme due to its better results in OS and toxicity profile.
Resumen
Objetivo
Evaluar y comparar la eficacia y seguridad de bevacizumab y aflibercept en segunda línea de tratamiento en el cáncer colorrectal metastásico (CCRm) en la práctica clínica real.
Métodos
Estudio observacional retrospectivo de los pacientes tratados con bevacizumab (BFIR) y aflibercept (AFIR) en segunda línea en CCRm, asociado a un esquema FOLFIRI, en los últimos 12 años (septiembre 2009-enero 2021) en un hospital de tercer nivel. Se incluyeron pacientes con tratamiento previo basado en oxaliplatino. Variables medidas: esquema previo, tiempo de tratamiento (TT), supervivencia libre de progresión (SLP), supervivencia global (SG). Para valorar toxicidad, se registraron los efectos adversos que provocaron retraso en la administración del ciclo. También se calcularon los ciclos perdidos/mes de tratamiento (CP/MT).
Resultados
84 pacientes [40 (47,6%) AFIR y 44 (52,4%) BFIR]. Media de edad: 60,2 ± 10,7 años. En el 79,8% el esquema previo fue tipo FOLFOX. Eficacia de AFIR vs BFIR: HR de mediana de TT (IC95%) = 0,816 (0,527–1,266); p = 0,365, HR de SLP (IC95%) = 0,674 (0,389–1,117); p = 0,159, HR de SG (IC95%) = 0,566 (0,342–0,936); p = 0,026. El principal motivo de retraso en la administración fue neutropenia (28,7% AFIR vs 24,7% BFIR), y el que más diferencia hubo entre ambos la trombopenia (13,9% AFIR vs 2,5% BFIR), sin observarse grandes diferencias entre el resto de reacciones adversas. Media de CP/MT: 0,49 ± 0,46 ciclos con AFIR y 0,33 ± 0,27 con BFIR; p = 0,046.
Conclusiones
Aunque no se han encontrado diferencias estadísticamente significativas en TT ni en SLP, sería más recomendable utilizar el esquema BFIR por sus mejores resultados en SG y perfil de toxicidad.
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Claramunt García, R., Muñoz Cid, C.L., Sánchez Ruiz, A. et al. Bevacizumab and aflibercept in second-line metastatic colorectal cancer: 12 years of experience. Eur J Clin Pharmacol 78, 287–291 (2022). https://doi.org/10.1007/s00228-021-03235-5
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DOI: https://doi.org/10.1007/s00228-021-03235-5