When would you consider first line FOLFOXIRI + Bevacizumab for metastatic colon cancer?

The phase III TRIBE study published in 2015 reported first line FOLFOXIRI with bevacizumab treatment had overall survival (OS) benefit compared with FOLFIRI/bevacizumab as first line treatment (29.8 months vs. 25.8 months, HR 0.80, p=0.03) (Cremolini et al., Lancet Oncol 2015). FOLFOXIRI/bevacizumab also showed prolonged progression free survival (PFS) and increased response rate (RR). However, this regimen is associated with increased grade 3 and 4 adverse events. The study did not answer the q...

I consider modified-FOLFOXIRI based chemotherapy (with targeted agents) for most patients and use this frequently. Our colon cancer patients are much more robust than pancreatic patients who receive FOLFIRINOX, in general.

I definitely use this for BRAF mutated patients, those with symptoms or extensive burden of disease (to more rapidly reduce tumor burden), and in general for poor prognosis MSS colon cancer patients. Furthermore, the updated TRIBE-2 results presented by Cremolini at ASCO 2019...

Great question! It's mportant to consider sidedness as well as the decision to not use anti-EGFR antibody. Here is a great review.