BACKGROUND: Bevacizumab and aflibercept are currently the mainstay of antiangiogenic therapy for metastatic colorectal carcinoma (mCRC). They are often used in sequence with first- and second-line chemotherapy, especially in patients with RAS-mutated tumours. OBJECTIVE: The aim of the present study was to investigate the outcomes of patients with mCRC treated with the bevacizumab-aflibercept sequence in real-world clinical practice. PATIENTS AND METHODS: Data from a national clinical registry of targeted therapies for mCRC were analysed retrospectively. Overall, there were 366 patients with valid data who received first-line treatment with bevacizumab and chemotherapy followed by aflibercept with chemotherapy. The majority of the patients (n = 296, 80.8%) had RAS mutated tumours. RESULTS: Median cumulative progression-free survival (PFS) from the start of the bevacizumab-containing regimen to progression on aflibercept was 18.2 months (95% CI 16.8-19.5). Median PFS for bevacizumab and aflibercept was 10.6 months (95% CI 9.5-11.7) and 5.6 months (95% CI 5.1-6.1), respectively. Longer PFS on aflibercept was associated with metachronous metastatic disease and longer PFS on bevacizumab. Median overall survival (OS) from the start of first-line bevacizumab was 32.0 months (95% CI 26.6-37.5). The presence of metastatic disease at diagnosis was associated with worse OS. CONCLUSIONS: Patients treated with aflibercept in real-world clinical practice achieved similar survival outcomes as those treated within randomised trials. Cumulative survival data provide a benchmark for future studies and enable indirect comparisons with other treatment sequences used in mCRC.

Biomedical Center Faculty of Medicine in Pilsen Charles University Alej Svobody 76 323 00 Pilsen Czech Republic

Department of Comprehensive Cancer Care Faculty of Medicine Masaryk Memorial Cancer Institute Masaryk University Zluty Kopec 543 7 656 53 Brno Czech Republic

Department of Oncology 1st Faculty of Medicine Charles University Thomayer University Hospital Videnska 800 140 59 Prague Czech Republic

Department of Oncology and Radiotherapeutics University Hospital in Pilsen Alej Svobody 80 304 60 Pilsen Czech Republic

Department of Oncology General University Hospital Charles University 1st Faculty of Medicine U Nemocnice 499 2 128 08 Prague Czech Republic

Department of Oncology Motol University Hospital 2nd Faculty of Medicine Charles University 5 Uvalu 84 150 00 Prague Czech Republic

Department of Oncology Palacky University Medical School and Teaching Hospital 1 P Pavlova 6 775 20 Olomouc Czech Republic

Institute of Biostatistics and Analyses Poštovská 68 3 602 00 Brno Czech Republic

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Med Oncol. 2017 Nov 4;34(12):193 PubMed

Cancer Sci. 2019 Mar;110(3):1032-1043 PubMed

Clin Cancer Res. 2010 Jan 1;16(1):358-66 PubMed

BMC Cancer. 2014 Aug 20;14:605 PubMed

Target Oncol. 2018 Dec;13(6):735-743 PubMed

Eur J Cancer. 2014 Jan;50(2):320-31 PubMed

J Clin Oncol. 2012 Oct 1;30(28):3499-506 PubMed

World J Clin Oncol. 2018 Sep 14;9(5):110-118 PubMed

Expert Opin Drug Saf. 2015 Aug;14(8):1171-9 PubMed

Ann Oncol. 2016 Aug;27(8):1386-422 PubMed

Ann N Y Acad Sci. 2002 Dec;979:80-93 PubMed

Lancet Oncol. 2013 Jan;14(1):29-37 PubMed

Asia Pac J Clin Oncol. 2016 Sep;12(3):275-83 PubMed

Clin Colorectal Cancer. 2018 Sep;17(3):e457-e470 PubMed

Target Oncol. 2017 Feb;12(1):89-95 PubMed

Genome Biol. 2005;6(2):209 PubMed

Eur J Cancer. 2009 Jan;45(2):228-47 PubMed

Clin Transl Oncol. 2017 Apr;19(4):498-507 PubMed

Future Oncol. 2018 Aug;14(20):2031-2044 PubMed

Cancer Med. 2019 Mar;8(3):882-889 PubMed

Angiogenesis. 2012 Jun;15(2):171-85 PubMed

Proc Natl Acad Sci U S A. 1991 Oct 15;88(20):9267-71 PubMed

Mol Cancer Ther. 2014 Jun;13(6):1636-44 PubMed

World J Clin Oncol. 2019 Feb 24;10(2):75-85 PubMed

Br J Cancer. 2015 Sep 29;113(7):1027-34 PubMed

Cancer Manag Res. 2018 Dec 28;11:359-368 PubMed