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Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Capecitabine and irinotecan with bevacizumab 2-weekly for metastatic colorectal cancer: the phase II AVAXIRI study

Authors: Pilar Garcia-Alfonso, Manuel Chaves, Andrés Muñoz, Antonieta Salud, Maria García-Gonzalez, Cristina Grávalos, Bartomeu Massuti, Encarna González-Flores, Bernardo Queralt, Amelia López-Ladrón, Ferran Losa, Maria Jose Gómez, Amparo Oltra, Enrique Aranda, on behalf of the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD)

Published in: BMC Cancer | Issue 1/2015

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Abstract

Background

The optimal sequence of chemotherapeutic agents is not firmly established for the treatment of metastatic colorectal cancer (mCRC). This phase II multi-centre study investigated the efficacy and tolerability of a standard capecitabine plus irinotecan (XELIRI) regimen with bevacizumab in previously untreated patients with mCRC.

Methods

Patients received intravenous irinotecan 175 mg/m2 on day 1 and oral capecitabine 1000 mg/m2 (800 mg/m2 for patients >65 years of age) twice daily on days 2–8, followed by a 1-week rest, and bevacizumab 5 mg/kg as an intravenous infusion on day 1 every 2 weeks.

Results

Seventy-seven patients were included in the intention-to-treat and safety populations. Progression-free survival at 9 months was 61%. The overall response and disease control rates were 51% and 84%, respectively. Median progression-free and overall survival times were 11.9 and 24.8 months, respectively. 48 patients (62%) had at least one grade 3/4 adverse event, the most common being asthenia, diarrhoea and neutropenia. Quality of life varied little over the study period with mean visual analogue scale general health scores ranging from 71 to 76 over cycles 1–11.

Conclusion

Our study found irinotecan and capecitabine administered fortnightly with bevacizumab in patients with mCRC to be an effective and tolerable regimen.

Trial registration

clinicaltrials.gov identifier NCT00875771. Trial registration date: 04/02/2009.
Appendix
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Literature
1.
go back to reference Ferlay J, Shin H, Bray F, Forman D, C Mathers, Parkin D. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. 2010. Lyon, France: International Agency for Research on Cancer. Available from: http://globocan.iarc.fr. Accessed on 10 November 2013. Ferlay J, Shin H, Bray F, Forman D, C Mathers, Parkin D. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. 2010. Lyon, France: International Agency for Research on Cancer. Available from: http://​globocan.​iarc.​fr. Accessed on 10 November 2013.
3.
go back to reference Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2012;23:2479–516.CrossRef Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2012;23:2479–516.CrossRef
4.
go back to reference Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.CrossRefPubMed Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.CrossRefPubMed
5.
go back to reference Saltz LB, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:2013–9.CrossRef Saltz LB, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:2013–9.CrossRef
6.
go back to reference Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, et al. Eastern Cooperative Oncology Group Study E3200: Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25:1539–44.CrossRef Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, et al. Eastern Cooperative Oncology Group Study E3200: Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25:1539–44.CrossRef
7.
go back to reference Bennouna J, Sastre J, Arnold D, Osterlund P, Greil R, Van Cutsem E, et al. ML18147 Study investigators: continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14:29–37.CrossRefPubMed Bennouna J, Sastre J, Arnold D, Osterlund P, Greil R, Van Cutsem E, et al. ML18147 Study investigators: continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14:29–37.CrossRefPubMed
8.
go back to reference Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25:4779–86.CrossRef Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25:4779–86.CrossRef
9.
go back to reference Köhne C-H, De Greve J, Hartmann JT, Lang I, Vergauwe P, Becker K, et al. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2008;19:920–6.CrossRef Köhne C-H, De Greve J, Hartmann JT, Lang I, Vergauwe P, Becker K, et al. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2008;19:920–6.CrossRef
10.
go back to reference Tewes M, Schleucher N, Achterrath W, Wilke HJ, Frings S, Seeber S, et al. Capecitabine and irinotecan as first-line chemotherapy in patients with metastatic colorectal cancer: results of an extended phase I study. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2003;14:1442–8.CrossRef Tewes M, Schleucher N, Achterrath W, Wilke HJ, Frings S, Seeber S, et al. Capecitabine and irinotecan as first-line chemotherapy in patients with metastatic colorectal cancer: results of an extended phase I study. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2003;14:1442–8.CrossRef
11.
go back to reference Borner MM, Bernhard J, Dietrich D, Popescu R, Wernli M, Saletti P, et al. A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2005;16:282–8.CrossRef Borner MM, Bernhard J, Dietrich D, Popescu R, Wernli M, Saletti P, et al. A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2005;16:282–8.CrossRef
12.
go back to reference Bajetta E, Di Bartolomeo M, Mariani L, Cassata A, Artale S, Frustaci S, et al. Randomized multicenter Phase II trial of two different schedules of irinotecan combined with capecitabine as first-line treatment in metastatic colorectal carcinoma. Cancer. 2004;100:279–87.CrossRefPubMed Bajetta E, Di Bartolomeo M, Mariani L, Cassata A, Artale S, Frustaci S, et al. Randomized multicenter Phase II trial of two different schedules of irinotecan combined with capecitabine as first-line treatment in metastatic colorectal carcinoma. Cancer. 2004;100:279–87.CrossRefPubMed
13.
go back to reference Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, Quiben-Pereira R, Gonzalez-Flores E, Perez-Manga G. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group. Br J Cancer. 2009;101:1039–43.CrossRefPubMedPubMedCentral Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, Quiben-Pereira R, Gonzalez-Flores E, Perez-Manga G. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group. Br J Cancer. 2009;101:1039–43.CrossRefPubMedPubMedCentral
14.
go back to reference Kolinsky K, Zhang Y-E, Dugan U, Heimbrook D, Packman K, Higgins B. Novel regimens of capecitabine alone and combined with irinotecan and bevacizumab in colorectal cancer xenografts. Anticancer Res. 2009;29:91–8.PubMed Kolinsky K, Zhang Y-E, Dugan U, Heimbrook D, Packman K, Higgins B. Novel regimens of capecitabine alone and combined with irinotecan and bevacizumab in colorectal cancer xenografts. Anticancer Res. 2009;29:91–8.PubMed
15.
go back to reference García-Alfonso P, Muñoz-Martin AJ, Alvarez-Suarez S, Jerez-Gilarranz Y, Riesco-Martinez M, Khosravi P, et al. Bevacizumab in combination with biweekly capecitabine and irinotecan, as first-line treatment for patients with metastatic colorectal cancer. Br J Cancer. 2010;103:1524–8.CrossRefPubMedPubMedCentral García-Alfonso P, Muñoz-Martin AJ, Alvarez-Suarez S, Jerez-Gilarranz Y, Riesco-Martinez M, Khosravi P, et al. Bevacizumab in combination with biweekly capecitabine and irinotecan, as first-line treatment for patients with metastatic colorectal cancer. Br J Cancer. 2010;103:1524–8.CrossRefPubMedPubMedCentral
16.
go back to reference Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.
19.
go back to reference Pectasides D, Papaxoinis G, Kalogeras KT, Eleftheraki AG, Xanthakis I, Makatsoris T, et al. XELIRI-bevacizumab versus FOLFIRI-bevacizumab as first-line treatment in patients with metastatic colorectal cancer: a Hellenic Cooperative Oncology Group phase III trial with collateral biomarker analysis. BMC Cancer. 2012;12:271.CrossRefPubMedPubMedCentral Pectasides D, Papaxoinis G, Kalogeras KT, Eleftheraki AG, Xanthakis I, Makatsoris T, et al. XELIRI-bevacizumab versus FOLFIRI-bevacizumab as first-line treatment in patients with metastatic colorectal cancer: a Hellenic Cooperative Oncology Group phase III trial with collateral biomarker analysis. BMC Cancer. 2012;12:271.CrossRefPubMedPubMedCentral
20.
go back to reference Souglakos J, Ziras N, Kakolyris S, Boukovinas I, Kentepozidis N, Makrantonakis P, et al. Randomised phase-II trial of CAPIRI (capecitabine, irinotecan) plus bevacizumab vs FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) plus bevacizumab as first-line treatment of patients with unresectable/metastatic colorectal cancer (mCRC). Br J Cancer. 2012;106:453–9.CrossRefPubMedPubMedCentral Souglakos J, Ziras N, Kakolyris S, Boukovinas I, Kentepozidis N, Makrantonakis P, et al. Randomised phase-II trial of CAPIRI (capecitabine, irinotecan) plus bevacizumab vs FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) plus bevacizumab as first-line treatment of patients with unresectable/metastatic colorectal cancer (mCRC). Br J Cancer. 2012;106:453–9.CrossRefPubMedPubMedCentral
21.
go back to reference Renouf DJ, Welch S, Moore MJ, Krzyzanowska MK, Knox J, Feld R, et al. A phase II study of capecitabine, irinotecan, and bevacizumab in patients with previously untreated metastatic colorectal cancer. Cancer Chemother Pharmacol. 2012;69:1339–44.CrossRefPubMed Renouf DJ, Welch S, Moore MJ, Krzyzanowska MK, Knox J, Feld R, et al. A phase II study of capecitabine, irinotecan, and bevacizumab in patients with previously untreated metastatic colorectal cancer. Cancer Chemother Pharmacol. 2012;69:1339–44.CrossRefPubMed
22.
go back to reference Ducreux M, Adenis A, Pignon J-P, François E, Chauffert B, Ichanté JL, et al. Efficacy and safety of bevacizumab-based combination regimens in patients with previously untreated metastatic colorectal cancer: final results from a randomised phase II study of bevacizumab plus 5-fluorouracil, leucovorin plus irinotecan versus bevacizumab plus capecitabine plus irinotecan (FNCLCC ACCORD 13/0503 study). Eur J Cancer Oxf Engl 1990. 2013;49:1236–45. Ducreux M, Adenis A, Pignon J-P, François E, Chauffert B, Ichanté JL, et al. Efficacy and safety of bevacizumab-based combination regimens in patients with previously untreated metastatic colorectal cancer: final results from a randomised phase II study of bevacizumab plus 5-fluorouracil, leucovorin plus irinotecan versus bevacizumab plus capecitabine plus irinotecan (FNCLCC ACCORD 13/0503 study). Eur J Cancer Oxf Engl 1990. 2013;49:1236–45.
23.
go back to reference White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 suppl 1):I–4–I–8. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 suppl 1):I–4–I–8.
24.
go back to reference Stein PD, Hull RD, Kayali F, Ghali WA, Alshab AK, Olson RE. Venous thromboembolism according to age: the impact of an aging population. Arch Intern Med. 2004;164:2260–5.CrossRefPubMed Stein PD, Hull RD, Kayali F, Ghali WA, Alshab AK, Olson RE. Venous thromboembolism according to age: the impact of an aging population. Arch Intern Med. 2004;164:2260–5.CrossRefPubMed
25.
go back to reference Kozloff M, Yood MU, Berlin J, Flynn PJ, Kabbinavar FF, Purdie DM, et al. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRiTE observational cohort study. Oncologist. 2009;14:862–70.CrossRefPubMed Kozloff M, Yood MU, Berlin J, Flynn PJ, Kabbinavar FF, Purdie DM, et al. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRiTE observational cohort study. Oncologist. 2009;14:862–70.CrossRefPubMed
26.
go back to reference Ardavanis A, Kountourakis P, Mantzaris I, Malliou S, Doufexis D, Sykoutri D, et al. Bevacizumab added to the irinotecan and capecitabine combination for advanced colorectal cancer: a well-tolerated, active and convenient regimen. Anticancer Res. 2008;28:3087–92.PubMed Ardavanis A, Kountourakis P, Mantzaris I, Malliou S, Doufexis D, Sykoutri D, et al. Bevacizumab added to the irinotecan and capecitabine combination for advanced colorectal cancer: a well-tolerated, active and convenient regimen. Anticancer Res. 2008;28:3087–92.PubMed
27.
go back to reference Hurwitz HI, Yi J, Ince W, Novotny WF, Rosen O. The clinical benefit of bevacizumab in metastatic colorectal cancer is independent of K-ras mutation status: analysis of a phase III study of bevacizumab with chemotherapy in previously untreated metastatic colorectal cancer. Oncologist. 2009;14:22–8.CrossRefPubMed Hurwitz HI, Yi J, Ince W, Novotny WF, Rosen O. The clinical benefit of bevacizumab in metastatic colorectal cancer is independent of K-ras mutation status: analysis of a phase III study of bevacizumab with chemotherapy in previously untreated metastatic colorectal cancer. Oncologist. 2009;14:22–8.CrossRefPubMed
28.
go back to reference Price TJ, Hardingham JE, Lee CK, Weickhardt A, Townsend AR, Wrin JW, et al. Impact of KRAS and BRAF gene mutation status on outcomes from the phase III AGITG MAX trial of capecitabine alone or in combination with bevacizumab and mitomycin in advanced colorectal cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29:2675–82.CrossRef Price TJ, Hardingham JE, Lee CK, Weickhardt A, Townsend AR, Wrin JW, et al. Impact of KRAS and BRAF gene mutation status on outcomes from the phase III AGITG MAX trial of capecitabine alone or in combination with bevacizumab and mitomycin in advanced colorectal cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29:2675–82.CrossRef
29.
go back to reference Bruera G, Cannita K, Di Giacomo D, Lamy A, Troncone G, Dal Mas A, et al. Prognostic value of KRAS genotype in metastatic colorectal cancer (MCRC) patients treated with intensive triplet chemotherapy plus bevacizumab (FIr-B/FOx) according to extension of metastatic disease. BMC Med. 2012;10:135.CrossRefPubMedPubMedCentral Bruera G, Cannita K, Di Giacomo D, Lamy A, Troncone G, Dal Mas A, et al. Prognostic value of KRAS genotype in metastatic colorectal cancer (MCRC) patients treated with intensive triplet chemotherapy plus bevacizumab (FIr-B/FOx) according to extension of metastatic disease. BMC Med. 2012;10:135.CrossRefPubMedPubMedCentral
30.
go back to reference Pickard AS, De Leon MC, Kohlmann T, Cella D, Rosenbloom S. Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med Care. 2007;45:259–63.CrossRefPubMed Pickard AS, De Leon MC, Kohlmann T, Cella D, Rosenbloom S. Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med Care. 2007;45:259–63.CrossRefPubMed
31.
go back to reference Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2013;22:1717–27.CrossRef Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2013;22:1717–27.CrossRef
Metadata
Title
Capecitabine and irinotecan with bevacizumab 2-weekly for metastatic colorectal cancer: the phase II AVAXIRI study
Authors
Pilar Garcia-Alfonso
Manuel Chaves
Andrés Muñoz
Antonieta Salud
Maria García-Gonzalez
Cristina Grávalos
Bartomeu Massuti
Encarna González-Flores
Bernardo Queralt
Amelia López-Ladrón
Ferran Losa
Maria Jose Gómez
Amparo Oltra
Enrique Aranda
on behalf of the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD)
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1293-y

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