Bevacizumab in combination with irinotecan, 5-fluorouracil and leucovorin given as first-line treatment of metastatic colorectal cancer

Abstract

Colorectal cancer (CRC) occurs predominantly in older people. It is the second leading cause of death from cancer among adults. Statistical power to assess risk/benefit from treatment in older patients is not different from that in younger patients. We report here the clinical benefit of bevacizumab plus 5-fluorouracil-based chemotherapy as first-line treatment in a 74-year-old female patient with metastatic CRC. The patient was admitted into a private hospital in November 2007 because of intestinal obstruction and ascites. Diagnosis was colon cancer clinical stage IV. She received the 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) regimen plus bevacizumab from January until July 2008. Toxicities were manageable. Because of the excellent response she had a re-laparotomy to restore bowel transit. Currently, she continues to use maintenance bevacizumab. This case report illustrates the possibility of adding bevacizumab to FOLFIRI in order to improve survival in patients with metastatic CRC. An analysis of pooled cohorts of patients aged 65 years and older from two similar trials in metastatic CRC has indicated that adding bevacizumab to 5-fluorouracil-based chemotherapy improved overall survival and progression-free survival similar to the benefits observed in younger patients. Also, the risks of treatment do not seem to exceed those in younger patients with metastatic CRC.

Fatal posterior revesible leukoencephalopathy syndrome associated coma induced by bevacizumab in metastatic colorectal cancer and review of literature

“…24 Bevacizumab may cause PRES via the following possible mechanisms: sudden blood pressure rise during bevacizumab treatment causes dysfunction of cerebral vascular autoregulation which results in vasogenic edema and eventually PRES. [44][45][46] PRES also may occur without hypertension development in patients receiving bevacizumab. Bevacizumab can disrupt the blood-brain barrier by extensively impairing the endothelium.…”

Suppressing the growth of rectal cancer xenografts derived from patient tumors by an adenovector expressing small hairpin RNA targeting Bcl‐XL

“…Because all three rectal cancer xenografts could be significantly suppressed by Ad/Bcl‐XL shRNA, tumor 16 was randomly chosen for treatment combined with 5‐Fu. 5‐Fu is one of the most frequently used chemotherapeutic agents for colon cancer in the clinic . To determine whether there are enhanced cell killing effects as a result of the combination of Ad/Bcl‐XL shRNA with 5‐Fu in vivo , mice were treated with 5‐Fu or Ad/Bcl‐XL shRNA, or both together.…”