Given the relatively mild toxicity profiles and the emergence of a number of relevant data sets, it is not surprising that most GOs, and Dr Venook, are generally continuing the fluoropyrimidine (FP) and biologic until disease progression or toxicity. The use of a primary chemotherapy partner is another story as more than two thirds of GOs administer irinotecan and oxaliplatin for a defined number of cycles, even if it is well tolerated, and then switch to a maintenance strategy. Dr Bendell agrees with this approach. She believes that most of the benefit of therapy will come earlier in the treatment course and is therefore willing to stop those agents before side effects become problematic.

Bendell JC et al. Treatment patterns and clinical outcomes in patients with metastatic colorectal cancer initially treated with FOLFOX-bevacizumab or FOLFIRI-bevacizumab: Results from ARIES, a bevacizumab observational cohort study. Oncologist 2012;17(12):1486-95. Abstract

Arnold D et al. Maintenance strategy with fluoropyrimidines (FP) plus bevacizumab (Bev), Bev alone, or no treatment, following a standard combination of FP, oxaliplatin (Ox), and Bev as first-line treatment for patients with metastatic colorectal cancer (mCRC): A phase III non-inferiority trial (AIO KRK 0207). Proc ASCO 2014;Abstract 3503.

Simkens LH et al. Optimal duration of systemic treatment in metastatic colorectal cancer. Curr Opin Oncol 2014;26(4):448-53. Abstract

Koopman M et al. Final results and subgroup analyses of the phase 3 CAIRO3 study: Maintenance treatment with capecitabine + bevacizumab versus observation after induction treatment with chemotherapy + bevacizumab in metastatic colorectal cancer (mCRC). Proc ASCO 2014;Abstract 3504.