Multicenter phase II study of biweekly CAPIRI plus bevacizumab as second-line therapy in patients with metastatic colorectal cancer (JSWOG-C3 study)

Abstract

Background: Triweekly capecitabine plus irinotecan (CAPIRI) was not a replacement for fluorouracil, leucovorin, and irinotecan (FOLFIRI) in the treatment of metastatic colorectal cancer (mCRC) because of the potential for greater toxicity. Recently, it has reported that mCAPIRI is well tolerated and non-inferior to FOLFIRI. In this study, we conducted a multicenter phase II trial to assess the efficacy and safety of biweekly CAPIRI plus bevacizumab as second-line chemotherapy for mCRC with reduced toxicity and preserved efficacy.

Methods: Patients with mCRC who had received prior chemotherapy, including oxaliplatin-based regimens, were eligible for this study. The treatment protocol administered capecitabine at 1000 mg/m² twice daily from the evening of day 1 to the morning of day 8, intravenous irinotecan at 150 mg/m² on day 1, and bevacizumab at 10 mg/kg on day 1 every 2 weeks. Primary endpoints for this study were progression-free survival (PFS) and safety. Secondary endpoints were overall survival (OS), time to treatment failure, response rate (RR), and disease control rate (DCR).

Results: Fifty-one patients were enrolled in this study. Median PFS was 5.5 months [95% confidence interval (CI) 4.23-7.40 months], and median OS was 13.5 months (95% CI 11.57-20.23 months). The RR was 14.6% (95% CI 6.5-28.4%), and the DCR was 66.7% (95% CI 51.5-79.2%). Hypertension was the most common Grade 3 adverse event (27.5%), followed by neutropenia (17.6%). Only two patients suffered from grade 3 hand-foot syndrome.

Conclusions: In mCRC patients, biweekly CAPIRI + bevacizumab appears effective and feasible as a second-line chemotherapy with relatively low toxicities, and has potential as a useful substitute for FOLFIRI + bevacizumab.

Keywords: Bevacizumab; Biweekly; CAPIRI; Second line; mCRC.

Fig. 1

Kaplan–Meier estimates of progression-free survival (PFS) in the full analysis set of metastatic colorectal cancer (mCRC) patients treated with biweekly CAPIRI + bevacizumab as second-line treatment. Median PFS was 5.5 months (95% CI 4.23–7.40 months)

Fig. 2

Kaplan–Meier estimates of overall survival (OS) in the full analysis set of mCRC patients treated with biweekly CAPIRI + bevacizumab as second-line treatment. Median OS was 13.5 months (95% CI 11.57–20.23 months)

Fig. 3

Kaplan–Meier estimates of time to treatment failure (TTF) in the full analysis set of mCRC patients treated with biweekly CAPIRI + bevacizumab as second-line treatment. Median TTF was 4.5 months (95% CI 3.97–6.93 months)

Fig. 4

Waterfall-plot analysis of maximum target lesion response compared to the baseline in patients with mCRC treated with second-line biweekly CAPIRI plus bevacizumab (N = 49). Apart from one patient administered anti-EGFR antibody, the other six patients who had target lesions increased over 20% used bevacizumab as first-line therapy. CAPIRI capecitabine plus irinotecan regimen

Fig. 5

Kaplan–Meier estimates of progression-free survival (PFS) in the full analysis set of metastatic colorectal cancer (mCRC) patients treated with bevacizumab versus anti-EGFR (cetuximab or panitumumab) as first-line treatment. Median PFS was 5.5 months (95% CI 4.43–10.33) and 6.8 months (95% CI 3.97–37.33) for the bevacizumab group and anti-EGFR group, respectively. Bev bevacizumab. p = 0.4, log-rank test