Oxaliplatin and 5-FU/folinic acid (modified FOLFOX6) with or without aflibercept in first line treatment of patients with metastatic colorectal cancer – the AFFIRM study
Mené sur 236 patients atteints d'un cancer colorectal métastatique, cet essai randomisé international de phase II évalue l'efficacité, du point de vue du taux de survie sans progression à 12 mois, et la toxicité de l'ajout d'aflibercept à une chimiothérapie mFOLFOX6 en traitement de première ligne
Background The combination of aflibercept with FOLFIRI has been shown to significantly prolong overall survival in patients with metastatic colorectal cancer (mCRC) after progression on oxaliplatin-based therapy. This trial evaluated the addition of aflibercept to oxaliplatin-based first-line treatment of patients with mCRC. Patients and methods Patients with mCRC were randomized to receive first-line therapy with mFOLFOX6 plus aflibercept (4 mg/kg) or mFOLFOX6 alone. The primary endpoint of this phase II study was the progression-free survival (PFS) rate at 12 months in each arm. The analysis of efficacy between the arms was a pre-planned secondary analysis. Results Of 236 randomized patients, 227 and 235 patients were evaluable for the primary efficacy analysis and safety, respectively. The probabilities of being progression-free at 12 months were 25.8% (95% CI:17.2–34.4) for the aflibercept/mFOLFOX6 arm and 21.2% (95% CI:12.2–30.3) for the mFOLFOX6 arm. The median PFS was 8.48 months (95% CI:7.89–9.92) for the aflibercept/mFOLFOX6 arm and 8.77 months (95% CI:7.62–9.27) for the mFOLFOX6 arm, the hazard ratio of aflibercept/mFOLFOX6 versus mFOLFOX6 was 1.00 (95% CI:0.74–1.36). The response rates were 49.1% (95% CI:39.7–58.6) and 45.9% (95% CI:36.4–55.7) for patients treated with and without aflibercept, respectively. The most frequent treatment-emergent grade 3/4 adverse events (AEs) excluding laboratory abnormalities reported for aflibercept/mFOLFOX6 versus mFOLFOX6 were neuropathy (16.8% vs. 17.2%) and diarrhea (13.4% vs. 5.2%). Neutropenia grade 3/4 occurred in 36.1% versus 29.3%. The most common VEGF inhibition class-effect grade 3/4 AEs for aflibercept/mFOLFOX6 versus mFOLFOX6 were hypertension (35.3% vs. 1.7%), proteinuria (9.2% vs. 0%), deep vein thrombosis (5.9% vs. 0.9%) and pulmonary embolism (5.9% vs. 5.2%). Conclusion No difference in PFS rate was observed between treatment groups. Adding aflibercept to first line mFOLFOX6 first-line did not increase efficacy but was associated with higher toxicity.