Efficacy of aflibercept with FOLFOX and maintenance with fluoropyrimidine as first-line therapy for metastatic colorectal cancer: GERCOR VELVET phase II study

Aflibercept in combination with 5-fluorouracil (5-FU)/irinotecan improves overall survival in the second-line therapy of patients with metastatic colorectal cancer (mCRC). In this study, we evaluated the effects of aflibercept in first-line therapy with FOLFOX followed by maintenance with fluoropyrimidine. VELVET was a prospective, single-arm multicenter phase II study (completed). Patients with previously untreated, unresectable, evaluable or measurable mCRC, with an age >= 18 years, and an ECOG performance status of 0-2 received 6 cycles of modified FOLFOX7 (5-FU/folinic acid and oxaliplatin) with aflibercept at 4 mg/kg every 2 weeks followed by maintenance therapy with fluoropyrimidine with aflibercept until disease progression or limiting toxicity. The reintroduction of oxaliplatin was performed at first progression. The primary endpoint was progression-free survival (PFS) at 6 months. From May, 2013 to May, 2014, 49 patients were included and 48 were evaluable for response. In total, 33 patients (67.4%) were alive without progression at 6 months. The Kaplan-Meier survival 6-month and 1-year PFS rates were 79.1 and 36.1%, respectively, and the median PFS was 9.3 months (95% CI, 8.3-12.5). The objective response rate was 59.2% (N=29/49). The most common (>= 10%) grade 3-4 adverse events were hypertension (23%), fatigue (15%), neutropenia (12%), neuropathy (12%) and stomatitis (10%). Three (6%) treatment-related deaths occurred: One from stroke, one from pulmonary embolism and one from neutropenic sepsis. On the whole, this study demonstrates the efficacy of aflibercept in combination with an oxaliplatin-based regimen in the first-line therapy of patients with mCRC. A strict monitoring of blood pressure and immediate management of hypertension during therapy is mandatory.