• Eric Van Cutsem, Florence Joulain, Paulo M Hoff, Edith Mitchell, Paul Ruff, Radek Lakomý, Jana Prausová, Vladimir M Moiseyenko, Guy van Hazel, David Cunningham, Dirk Arnold, Hans-Joachim Schmoll, Albert J Ten Tije, Joseph McKendrick, Hendrik Kröning, Yves Humblet, Cristina Grávalos, Solenn Le-Guennec, Michael Andria, Emmanuelle Dochy, Raghu L Vishwanath, Teresa Macarulla, and Josep Tabernero.
• Digestive Oncology, University Hospitals Gasthuisberg/Leuven, Leuven, Belgium. Eric.VanCutsem@uzleuven.be.
• Target Oncol. 2016 Jun 1; 11 (3): 383-400.

AbstractThe aim of this post hoc analysis of the VELOUR study (ClinicalTrials.gov NCT00561470) was to investigate the treatment effect of adding aflibercept to second-line infusional 5-fluorouracil (5-FU), leucovorin and irinotecan (FOLFIRI) in patients with metastatic colorectal cancer (mCRC) who had failed any prior oxaliplatin-containing regimen. Adjuvant rapid relapsers (ARR), who were enrolled directly following relapse during or within 6 months of completion of oxaliplatin-containing adjuvant chemotherapy (N = 124, including 17 patients who also received bevacizumab as part of their adjuvant therapy), were excluded from the original VELOUR intention-to-treat (ITT) population (N = 1226). After exclusion of the ARR, overall survival (OS) in the ITT minus ARR (ITT-ARR) population (N = 1102) was longer in the aflibercept plus FOLFIRI arm than in the placebo plus FOLFIRI arm [hazard ratio (HR) 0.78, 95 % confidence interval (CI) 0.68-0.90; median survival difference 1.87 months]. In the subgroup of patients assigned to the prior bevacizumab stratum at randomization, OS was numerically longer in the aflibercept plus FOLFIRI arm than in the placebo plus FOLFIRI arm (HR 0.81; 95 % CI 0.63-1.04; median survival difference 2.14 months). Comparison of the post hoc analysis results with the primary analysis from VELOUR suggests that the inclusion of the directly enrolled ARR may have understated the aflibercept treatment benefit for both bevacizumab-pretreated and bevacizumab-naïve patients in the strictly second-line setting although no definitive conclusion may be inferred. The benefit associated with the addition of aflibercept to second-line FOLFIRI in patients with mCRC was observed whatever the timing of first-line disease progression. There were no unexpected safety concerns.

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