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Van Cutsem E, Tabernero J, Lakomy R, Prenen H, Prausová J, Macarulla T, Ruff P, van Hazel GA, Moiseyenko V, Ferry D, McKendrick J, Polikoff J, Tellier A, Castan R, Allegra C. Addition of Aflibercept to Fluorouracil, Leucovorin, and Irinotecan Improves Survival in a Phase III Randomized Trial in Patients With Metastatic Colorectal Cancer Previously Treated With an Oxaliplatin-Based Regimen. J Clin Oncol 2012; 30:3499-506. [PMID: 22949147 DOI: 10.1200/jco.2012.42.8201] [Citation(s) in RCA: 954] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Treatment for metastatic colorectal cancer (mCRC) commonly involves a fluoropyrimidine-based chemotherapy regimen such as infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) or fluorouracil, leucovorin, and oxaliplatin, often combined with bevacizumab or an epidermal growth factor receptor monoclonal antibody. We studied the effect of adding the novel antiangiogenic agent aflibercept (also known as ziv-aflibercept in the United States) to FOLFIRI in patients with mCRC previously treated with oxaliplatin, including patients who received prior bevacizumab. Patients and Methods Patients were randomly assigned to receive aflibercept (4 mg/kg intravenously; 612 patients) or placebo (614 patients) every 2 weeks in combination with FOLFIRI. Treatment was administered until disease progression or unacceptable toxicity. The primary end point was overall survival. Results Adding aflibercept to FOLFIRI significantly improved overall survival relative to placebo plus FOLFIRI (hazard ratio [HR], 0.817; 95.34% CI, 0.713 to 0.937; P = .0032) with median survival times of 13.50 versus 12.06 months, respectively. Aflibercept also significantly improved progression-free survival (PFS; HR, 0.758; 95% CI, 0.661 to 0.869; P < .0001), with median PFS times of 6.90 versus 4.67 months, respectively. The effects on overall survival and PFS exhibited a consistent trend across prespecified subgroup analyses, including bevacizumab pretreated patients. Response rate was 19.8% (95% CI, 16.4% to 23.2%) with aflibercept plus FOLFIRI compared with 11.1% (95% CI, 8.5% to 13.8%) with placebo plus FOLFIRI (P = .0001). Adverse effects reported with aflibercept combined with FOLFIRI included the characteristic anti–vascular endothelial growth factor effects and also reflected an increased incidence of some chemotherapy-related toxicities. Conclusion Aflibercept in combination with FOLFIRI conferred a statistically significant survival benefit over FOLFIRI combined with placebo in patients with mCRC previously treated with oxaliplatin.
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Affiliation(s)
- Eric Van Cutsem
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Josep Tabernero
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Radek Lakomy
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Hans Prenen
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Jana Prausová
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Teresa Macarulla
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Paul Ruff
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Guy A. van Hazel
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Vladimir Moiseyenko
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - David Ferry
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Joe McKendrick
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Jonathan Polikoff
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Alexia Tellier
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Rémi Castan
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
| | - Carmen Allegra
- Eric Van Cutsem and Hans Prenen, University Hospital Gasthuisberg, Leuven, Belgium; Josep Tabernero and Teresa Macarulla, Vall d'Hebron University Hospital, Barcelona, Spain; Radek Lakomy, Masaryk Memorial Cancer Institute, Brno; Jana Prausová, Fakultni nemocnice v Motole, Prague, Czech Republic; Paul Ruff, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Guy A. van Hazel, University of Western Australia, Western Australia; Joe McKendrick, Monash University, Victoria,
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