SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Thomas APARICIO
Coup de coeur :
 
 
Annals of oncology
  2018/01  
 
  2018 Jan 1;29(1):133-138.  
  doi: 10.1093/annonc/mdx529.  
 
  Bevacizumab + chemotherapy versus chemotherapy alone in elderly patients with untreated metastatic colorectal cancer: a randomized phase II trial - PRODIGE 20 study results.  
 
  Aparicio T, Bouché O, Taieb J, Maillard E, Kirscher S, Etienne PL, Faroux R, Khemissa Akouz F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Paillaud E, Retornaz F, François E, Bedenne L; for PRODIGE 20 Investigators.  
  https://www.ncbi.nlm.nih.gov/pubmed/29045659  
 
 

Abstract

BACKGROUND:

Metastatic colorectal cancer frequently occurs in elderly patients. Bevacizumab in combination with front line chemotherapy (CT) is a standard treatment but some concern raised about tolerance of bevacizumab for these patients. The purpose of PRODIGE 20 was to evaluate tolerance and efficacy of bevacizumab according to specific end points in this population.

PATIENTS AND METHODS:

Patients aged 75 years and over were randomly assigned to bevacizumab + CT (BEV) versus CT. LV5FU2, FOLFOX and FOLFIRI regimen were prescribed according to investigator's choice. The composite co-primary end point, assessed 4 months after randomization, was based on efficacy (tumor control and absence of decrease of the Spitzer QoL index) and safety (absence of severe cardiovascular toxicities and unexpected hospitalization). For each arm, the treatment will be consider as inefficient if 20% or less of the patients met the efficacy criteria and not safe if 40% or less met the safety criteria.

RESULTS:

About 102 patients were randomized (51 BEV and 51 CT), median age was 80 years (range 75-91). Primary end point was met for efficacy in 50% and 58% and for safety in 61% and 71% of patients in BEV and CT, respectively. Median progression-free survival was 9.7 months in BEV and 7.8 months in CT. Median overall survival was 21.7 months in BEV and 19.8 months in CT. The 36-month overall survival rate was 27% in BEV and 10.1% in CT. Severe toxicities grade 3/4 were mainly non-hematologic toxicities (80.4% in BEV, 63.3% in CT).

CONCLUSION:

Bevacizumab combined with CT was safe and efficient. Both arms met the primary safety and efficacy criteria.

 

 
Question posée
 
Alors que la population de patients âgés de plus 75 ans avec un cancer colorectal métastatique représente plus de 30%, celle-ci est le plus souvent exclue des essais thérapeutiques. Cette étude évalue l'intérêt de l'ajout du bévacizumab à la chimiothérapie en 1ère ligne de traitement d'un cancer colorectal métastatique chez les patients âgés (toxicité, qualité de vie et efficacité).
 
Question posée
 
La tolérance de la chimiothérapie plus bévacizumab est acceptable avec une tendance à une augmentation de la survie sans progression (9,7 mois versus 7,8 mois, HR=0,79, 95% CI 0,53-1,17) et de la survie globale (21,7 mois versus 19,8 mois, HR=0,73, 95% CI 0,48-1,11) par rapport au bras chimiothérapie seule.
 
Commentaires

Il s’agit d’une étude de phase II non comparative qui ne permet pas de conclure à la supériorité de l’ajout du bévacizumab à la chimiothérapie par rapport à la chimiothérapie seule chez les patients de plus de 75 ans. Ces résultats sont à confirmer dans un essai de phase III.

 
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