In the United States in 2017, there are projected to be 135 430 individuals newly diagnosed with colorectal cancer and 50 260 deaths from the disease with 18% to 22% having distant metastatic diseases at the time of diagnosis.1 Over the past decade or more, significant effort has been devoted to optimize first-line treatment for advanced and metastatic colorectal cancer. It has been established that overall survival is similar if patients are initially treated with FOLFOX (the combination of fluororuacil with leucovorin and oxaliplatin) or FOLFIRI (the combination of fluororuacil with leucovorin and irinotecan).2 Several large phase 3 studies have investigated the addition of targeted therapy against vascular endothelial growth factor (VEGF) (with bevacizumab) and epidermal growth factor-receptor (EGFR) (with cetuximab and panitumumab) in the first-line setting compared with chemotherapy alone, showing overall survival benefit with the use of these agents.3-6 Two large studies that investigated the combination of chemotherapy and “double biologics” (simultaneous VEGF and EGFR inhibition) have demonstrated increased toxicity and decreased efficacy compared with chemotherapy and bevacizumab alone.7,8
Lieu CH, Messersmith WA. Cetuximab or Bevacizumab With First-Line Chemotherapy in Advanced KRAS Wild-Type Colorectal Cancer: No Difference, but Not the Same. JAMA. 2017;317(23):2376–2378. doi:10.1001/jama.2017.6673
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