Dr. Cohen on the Standardization of Triplet Chemotherapy in CRC

Stacey A. Cohen, MD, physician, Seattle Cancer Care Alliance, associate professor, Division of Medical Oncology, University of Washington (UW) School of Medicine, physician, UW Medicine, associate professor, Clinical Research Division, Fred Hutchinson Cancer Research Center, discusses the standardization of triplet-based chemotherapy regimens in colorectal cancer (CRC).

Data evaluating triplet-based chemotherapy strategies in CRC have largely demonstrated improved progression-free survival (PFS) with triplet combinations vs doublet combinations, Cohen explains. However, it was unclear whether the triplet regimens extended overall survival (OS) long-term compared with doublets, given that the 3-drug combinations were associated with increased toxicity, Cohen says.

Data from the phase 3 TRIBE2 study (NCT02339116), which compared upfront FOLFOXIRI plus bevacizumab (Avastin), followed by reintroduction with FOLFOXIRI plus bevacizumab at progression vs modified FOLFOX6 (mFOLFOX6) plus bevacizumab, followed by FOLFIRI plus bevacizumab in patients with metastatic CRC, showed improved PFS and OS with the FOLFOXIRI-based approach, Cohen explains.

The findings of TRIBE2 resulted in the standardization of the FOLFOXIRI-based treatment regimen for patients with CRC and the approach is being utilized with increasing frequency, Cohen says. Moreover, patients with peritoneal disease, who are expected to have poor prognoses, can receive triplet regimens the TRIBE2 data and the other studies, Cohen concludes.