Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.295
Peer-review started: December 28, 2020
First decision: January 17, 2021
Revised: January 28, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: April 15, 2021
We usually use angiogenesis inhibitors (AIs) for chemotherapy in metastatic colorectal cancer (CRC). Aflibercept (AFL), one of the AIs, has been shown to be effective in second-line treatment by the ‘VELOUR’ study.
We can choose three Ais-bevacizumab, ramucirumab, and AFL-for treating with second-line chemotherapy. No means of choosing among the three AIs has been established because of the absence of direct comparisons.
We researched whether AFL is a treatment option for second-line chemotherapy with CRC in the ordinary clinical setting in Akita, Japan.
Medical records including age, sex, primary tumor location, RAS and BRAF status, metastatic sites, cycles of prior chemotherapies, survival time after initial AFL administration, etc. were collected from each institution. We investigated the efficacy and safety for AFL via a statistical approach.
Time to AFL treatment failure was 123 d in the second-line group and 71 d in the salvage therapy group. The median survival time post-AFL was 673 d in the second-line group and 396 d in the salvage therapy group. Adverse events of grade ≥ 3 occurred in 8 patients (36%) in the second-line group and 9 patients (47%) in the salvage therapy group.
Our study indicated that the efficacy and safety was the same as in the VELOUR study and that AFL contributes survival benefit similarly in both the second-line and salvage therapy settings. Patients with unresectable metastatic CRC should consider receiving AFL, regardless of number of treatment cycles.
AFL is a promising agent, along with chemotherapy, for CRC. Further study should verify whether AFL will be affected by sequential therapy; for example, investigating the particular regimen used as first-line therapy before AFL administration.