Combining Bevacizumab with FOLFIRI Improves Progression Free Survival as a Second-Line Treatment in Metastatic Colorectal Cancer Patients

Introduction: Clinical trials have shown that bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor is effective in treating metastatic colorectal cancer (mCRC). Available evidence suggests that it is more effective in combination with chemotherapy acting in synergy. In this study, we assessed the efficacy and safety of bevacizumab combined with capeOX/FOLFOX or FOLFIRI emphasizing which combination therapy is best as a first, second, or third-line treatment for mCRC. Material and method: We reanalyzed secondary data from the DRYAD database that contained follow-up information on the combination use of bevacizumab with either capeOX/FOLFOX or FOLFIRI to treat mCRC. 147 mCRC patients were involved and the data was collected until December 30, 2019. Kaplan-Meier survival curves, Log-Rank tests, and Cox proportional hazards models were employed for analysis. All analyses were conducted using SPSS version 27. Results: From uunivariate analyses, higher ECOG status (HR 1.411, 95% CI: 1.137 – 1.977, p = 0.019), radical surgery of the primary organ (HR 0.649, 95% CI: 0.348 – 0.909, p = 0.033), the presence of ≥2 metastatic sites (HR 1.638, 95% CI: 1.189 – 1.907, p = 0.014), and the type of chemotherapy used (HR 0.563, 95% CI: 0.316 – 0.971, p = 0.036) were significantly associated with overall survival (OS). Multivariate analysis showed type of chemotherapy used (HR 0.463, 95% CI: 0.216 – 0.992, p = 0.048) as an independent predictor of OS. Kaplan-Meier survival analysis showed that patients receiving bevacizumab plus FOLFIRI as a second-line therapy had better progression-free survival (PFS) Conclusion: Type of chemotherapy combined with bevacizumab independently influences overall survival (OS) in mCRC patients. Bevacizumab showed greater efficacy in extending progression-free survival (PFS) when paired with FOLFIRI rather than capeOX or FOLFOX.