The safety and effectiveness of Bevacizumab in Metastatic Colorectal Cancer with Unresectable Metastases: A Real-Life Study from the south of Morocco

Abstract

Colorectal cancer constitutes a significant public health challenge, yet remarkable strides have been made in the last two decades, particularly in the medical management of metastatic stages. Notable progress has been achieved through targeted therapies such as Anti-EGFR or Anti-Angiogenic Antibodies, as well as advancements in surgical approaches for hepatic metastases. This study seeks to assess the efficacy and safety of Bevacizumab Plus Chemotherapy in individuals dealing with metastatic colorectal cancer." This is a observational cross-sectional retrospective study of all the patients who were followed up for metastatic colorectal cancer with unresectable metastases and were treated by Bevacizumab in combination with a standard chemotherapy from January 2010 until December 2019 in the medical oncology department of the CHU Souss Massa of Agadir. Of the total 162 cases,72% patients were with metastatic disease, 28% progressed to metastatic disease after initial treatment. The median age of patients were 55 (23–79 years) with a sex ratio of 1.1 (M / F) .The tumor was located in the left colon in 83.4% of the patients. The results represented: adenocarcinoma in 84,6% of the cases and mucinous subtype in 14.19% .The three most common sites of metastasis were: liver 61.6%,peritoneum 41.5% and lung 20.37%. In the first line, 100% of the patients received bi-chemotherapy plus bevacizumab: XELOX 54.3% ,FOLFOX 20.9%, XELERI 14.1% and FOLFIRI 10.4%. Response after first-line treatment were: 45,7% progression, 25.9% stability, 21.6% partial response, 6,8% complete response. 6% of patients were able to benefit from surgical resection of metastatic lesions. 25,8% of patients received 5FU in 2nd line chemotherapy with irinotecan in 20.7% of the cases or with oxaliplatin in 5.1% of the cases. Two patients developed undesirable side-effects under bevacizumab (hypertension). The median progression-free survival and median overall survival of study cohort were 9 months and 14 months respectively. Nevertheless, patients who underwent primary tumor resection (p 0.048), those with rightsided tumors (p 0.022), those who received a higher number of treatment cycles (p 0.020) and those who received maintenance treatment (p 0.001) had a longer median OS . Chemotherapy combination with bevacizumab is considered as the cornerstone of mCRC treatment in our region. With the new healthcare and social security systems, easier access to expensive treatments and molecular pathology tests is currently available. It is important to highlight that real world data can offer valuable insights for daily clinical practice of medical oncology.