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Tesi etd-03192020-192005


Thesis type
Tesi di laurea magistrale LM6
Author
VITUCCI, SERENA
URN
etd-03192020-192005
Title
Trattamento dopo la progressione alla terapia di prima linea con FOLFOXIRI più bevacizumab in pazienti con carcinoma colorettale metastatico: analisi combinata degli studi TRIBE e TRIBE2 del Gruppo Oncologico Nord Ovest
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Supervisors
relatore Prof. Masi Gianluca
Parole chiave
  • TRIBE
  • TRIBE2
Data inizio appello
07/04/2020;
Consultabilità
Secretata d'ufficio
Data di rilascio
07/04/2090
Riassunto analitico
FOLFOXIRI + Bevacizumab is a first-line regimen of proven activity and efficacy in metastatic colorectal cancer patients (mCRC). However, some concerns remain about subsequent second-line therapy, as failure of an oxaliplatin and irinotecan-based regimen may limit the clinical benefit of their reintroduction. In order to explore the feasibility of therapies following upfront FOLFOXIRI + Bevacizumab, we retrospectively analyzed the efficacy of second-line treatments after first-line triplet + Bevacizumab failure in patients recruited in the phase III TRIBE (NCT00719797) and TRIBE2 (NCT02339116) studies. Furthermore, we investigated the correlation between the efficacy of FOLFOXIRI reintroduction and oxalilplatin and irinotecan free interval (OIFI), determined as the time from the last administration of these two agents to disease progression.Among the 1187 screened patients, 588 were treated with upfront FOLFOXIRI + Bevacizumab. 419 patients received a second-line therapy and were included in the analysis. Efficacy and activity were explored as Progression Free Survival to second-line therapy (2nd PFS), Overall Survival (OS) and Overall Response Rate (ORR). The OIFI cut-off value was set to 4 months.
A second-line treatment was administered in 419 (80%) out of 527 patients progressed to upfront FOLFOXIRI + Bevacizumab. 176 (42%) were retreated with FOLFOXIRI ± Bevacizumab, gaining an advantage in ORR (22.7% vs 13.7%, p=0.011) and 2nd PFS over other regimens (6.1 vs 4.2 months, p=0.004). In the subgroup retreated after an OIFI > 4 months, triplet chemotherapy (CT) ± Bevacizumab outperformed doublet CT ± Bevacizumab (7.2 vs 5.5 months, p=0.017). FOLFOXIRI ± Bevacizumab reintroduction was not superior to other second-line treatments in terms of OS (13.7 vs 11.9 months, p=0.49). Progression to first-line FOLFOXIRI + Bevacizumab does not preclude the administration of an intensive and active second-line CT. Patients readministered with oxalilplatin and irinotecan after a longer OIFI seem to derive a greater advantage respect to the use of other strategies.
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