Use of FOLFOXIRI Plus Bevacizumab and Subsequent Therapies in Metastatic Colorectal Cancer: An Age-Stratified Analysis

Abstract

BackgroundTreatment recommendations for metastatic colorectal cancer (mCRC) do not differ by age group; nevertheless, aggressive multi-agent chemotherapy comprising FOLFOXIRI+bevacizumab (triplet+bev) is routinely administered in younger patients. This study analyzed real-world data on index triplet+bev use and subsequent systemic therapies. Materials and MethodsThis retrospective, observational cohort study was conducted in patients aged ≥18 years with mCRC, who were initiated on triplet+bev. Data were derived from the Optum® de-identified electronic health record dataset. ResultsOf 36,056 patients, 14%, 36%, and 50% were aged 18–49, 50–64, and ≥65 years, respectively. During the study period (2010–2021), triplet+bev use increased in patients aged 18–49 years (1–4%) but remained at approximately 3% and 1% in patients aged 50–64 and ≥65 years, respectively. Patient demographics and clinical characteristics varied slightly; of patients receiving triplet+bev (n = 921) versus non-triplet+bev (n = 35,132) most were male (57% vs. 52%), resided in the Midwest (54% vs. 49%) and Northeast (18% vs. 14%) US regions, and had secondary malignancies (86% vs. 73%). Following triplet+bev, most patients received subsequent therapies (including continued triplet component therapies; 97%) or subsequent ‘new’ therapies (therapies that did not include any agents comprising triplet+bev; 57%), most frequently EGFR inhibitors (28%) and regorafenib (21%), with a similar trend among all age groups. ConclusionsOverall, this study shows that younger patients with mCRC are more likely to receive first-line triplet+bev. These results also reveal that non-chemotherapy options are often used beyond first-line triplet chemotherapy for patients with mCRC. MicroAbstractWe conducted an analysis of electronic health records to assess FOLFOXIRI+bevacizumab (triplet+bev) use and subsequent therapies in adult patients with metastatic colorectal cancer. Results showed increasing triplet+bev use over time in patients aged <65 years and administration of ‘new’ subsequent therapies (not including any agents comprising triplet+bev) in over half of the study population, consistent with available evidence.