Two-drug combinations of fluorouracil (plus leucovorin) and either irinotecan (FOLFIRI) or oxaliplatin (FOLFOX), together with bevacizumab, are standard first-line treatments for metastatic colorectal cancer.
However, phase III study results reported in The
New England Journal of Medicine (online, 23 October 2014) by Alfredo Falcone, from Universitaria Pisana, Italy, suggest that a triple-drug combination — comprising fluorouracil (plus leucovorin), oxaliplatin and irinotecan (FOLFOXIRI) — plus bevacizumab, offers incremental improvements in patient outcome
When evaluated in 508 patients with untreated metastatic colorectal cancer, FOLFOXIRI plus bevacizumab had a hazard ratio of 0.75 for disease progression (95% confidence interval [CI] 0.62 to 0.90; P=0.003) and 0.79 for death (CI 0.63 to 1.00; P=0.054), as compared with FOLFIRI plus bevacizumab. The superior efficacy was accompanied by significantly higher rates of grade 3 or 4 neurotoxicity, stomatitis, diarrhoea and neutropenia.
 Loupakis F, Cremolini C, Masi G et al. Initial Therapy with FOLFOXIRI and Bevacizumab for Metastatic Colorectal Cancer. N Engl J Med 2014;371:1609-18. doi: 10.1056/NEJMoa1403108 (accessed 23 October 2014).