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Background: Obtaining early tumor shrinkage, defined as 20% shrinkage in tumor size per RECIST criteria at the first radiological assessment (8 weeks of treatment), has been shown to be prognostic for improved survival of patients with mCRC treated with cetuximab with or without chemotherapy. The aim of our study was to evaluate the impact of this parameter in patients treated with first-line of chemotherapy combining fluoropyrimidine, irinotecan, and bevacizumab.Methods: All pts who received first-line chemotherapy combining fluoropyrimidine, irinotecan, and bevacizumab for unresectable mCRC, between March 2012 and May 2015, were included in an exploratory analysis of survival based on the presence or not of ETS. The univariate analysis of the PFS and OS was based on the Kaplan-Meier method and the Log-Rank test. Multivariate analysis was performed using a Cox model including ETS, sex and Köhne prognostic score.Results: Fifty-two patients were enrolled; median age was 59 years (range 32-75), performance status 0-1 was 84.6%. 69.2% had multi-organ involvement. The median follow-up was 40 months. Fifty-one patients were evaluable for response: ORR 39.2%, SD 43.1 for a clinical benefit of 82.3%. 33% qualified for early response. Median PFS and OS for the whole group was 11 months (95% CI: 7.8-14.2) and 20.8 months (95% CI: 16.5-25.1), respectively. ETS was associated with prolonged PFS and OS (22.5 vs 10.3 months, p ¼ 0.001; 52 vs 20 months, p< 0.0001). Conclusion:Early response to chemotherapy may predict favorable outcomes in patients with metastatic CRC treated with first-line bevacizumab plus chemotherapy, but large prospective analysis and validation are mandatory.Legal entity responsible for the study: The authors.Funding: Has not received any funding. Disclosure:The presenting author has declared no conflicts of interest.

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