Elsevier

Annals of Oncology

Volume 26, Issue 4, April 2015, Pages 702-708
Annals of Oncology

original articles
gastrointestinal tumors
Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial

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ABSTRACT

OLIVIA, a multinational phase II study, suggests that bevacizumab plus FOLFOXIRI improves outcomes, including response rates, resection rates, and progression-free survival, compared with bevacizumab plus mFOLFOX-6 in patients with initially unresectable liver metastases from colorectal cancer.

Background

For patients with initially unresectable liver metastases from colorectal cancer, chemotherapy can downsize metastases and facilitate secondary resection. We assessed the efficacy of bevacizumab plus modified FOLFOX-6 (5-fluorouracil/folinic acid, oxaliplatin) or FOLFOXIRI (5-fluorouracil/folinic acid, oxaliplatin, irinotecan) in this setting.

Patients and methods

OLIVIA was a multinational open-label phase II study conducted at 16 centres in Austria, France, Spain, and the UK. Patients with unresectable liver metastases were randomised to bevacizumab (5 mg/kg) plus mFOLFOX-6 [oxaliplatin 85 mg/m2, folinic acid 400 mg/m2, 5-fluorouracil 400 mg/m2 (bolus) then 2400 mg/m2 (46-h infusion)] or FOLFOXIRI [oxaliplatin 85 mg/m2, irinotecan 165 mg/m2, folinic acid 200 mg/m2, 5-fluorouracil 3200 mg/m2 (46-h infusion)] every 2 weeks. Unresectability was defined as ≥1 of the following criteria: no possibility of upfront R0/R1 resection of all lesions; <30% residual liver volume after resection; metastases in contact with major vessels of the remnant liver. Resectability was evaluated by multidisciplinary review. The primary end point was overall resection rate (R0/R1/R2). Efficacy end points were analysed by intention-to-treat analysis.

Results

In patients assigned to bevacizumab–FOLFOXIRI (n = 41) or bevacizumab–mFOLFOX-6 (n = 39), the overall resection rate was 61% [95% confidence interval (CI) 45% to 76%] and 49% (95% CI 32% to 65%), respectively (difference 12%; 95% CI -11% to 36%). R0 resection rates were 49% and 23%, respectively. Overall tumour response rates were 81% (95% CI 65% to 91%) with bevacizumab–FOLFOXIRI and 62% (95% CI 45% to 77%) with bevacizumab–mFOLFOX-6. Median progression-free survival (PFS) was 18·6 (95% CI 12.9–22.3) months and 11·5 (95% CI 9.6–13.6) months, respectively. The most common grade 3–5 adverse events were neutropenia (bevacizumab–FOLFOXIRI, 50%; bevacizumab–mFOLFOX-6, 35%) and diarrhoea (30% and 14%, respectively).

Conclusions

Bevacizumab–FOLFOXIRI was associated with higher response and resection rates and prolonged PFS versus bevacizumab–mFOLFOX-6 in patients with initially unresectable liver metastases from colorectal cancer. Toxicity was increased but manageable with bevacizumab–FOLFOXIRI.

ClinicalTrials.gov

NCT00778102.

Key words

bevacizumab
liver metastases
secondary resection
chemotherapy
colorectal cancer

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