How do you decide between continuing 5FU + Chemo (Oxaliplatin or Irinotecan) + Bevacizumab versus switching to maintenance 5FU + Bevacizumab in the first line setting for metastatic colon cancer?

In general, after 4-6 months of induction chemotherapy, if they experience a favorable response, I would favor maintenance chemotherapy based off several clinical trials which have shown a benefit for a maintenance approach, notably OPTIMOX and CAIRO-3. The continuation of oxaliplatin or irinotecan can be problematic due to several reasons. One, both drugs can cause significant hepatotoxicity, while oxaliplatin can cause issues with splenomegaly and subsequent thrombocytopenia. These underlying ...