Expert Point of View: Tim Maughan, MD

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Maintenance treatment with capecitabine plus bevacizumab can be considered in clinical practice, according to Tim Maughan, MD, Professor of Clinical Oncology at Oxford University in the United Kingdom, who discussed CAIRO3 at the session.

He said that approximately 60% of patients with metastatic colorectal cancer will have their disease controlled, but not cured, by first-line chemotherapy. The best approach to preventing recurrence is still being determined, he commented.

“It is important to include our patients in this conversation,” he emphasized. “They are thinking not only about survival but also about time free of cancer symptoms, treatment side effects, visits to the doctor, financial pressure, and worry—time to live life normally.”

Robust Series of Endpoints

“I was impressed by the robustness of the series of primary and secondary endpoints in the study.… Among all the trial of chemotherapy-free intervals vs maintenance, CAIRO3 shows the most benefit in interval progression-free survival,” he noted. “Overall survival, however, remains the key endpoint for registration, for our patients, and for changing practice. In CAIRO3, this was about 3.5 months—modest, but statistically significant,” he noted.

That said, is the benefit due to the combination of the two drugs or to one or the other alone? “The lack of benefit from bevacizumab monotherapy shown in the [Swiss Group for Clinical Cancer Research (SAKK)] 41/06 study1 and the benefit of fluoropyrimidine maintenance in the [Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR)] OPTIMOX2 study2 suggest that the fluoropyrimidine component certainly makes a major—and possibly the dominant—contribution,” he told The ASCO Post. “Further, it is not clear which patients benefit from maintenance therapy, and it is likely that this is a subset of patients. Further work is required to address this question,” he said.

“While some questions remain, and the combination is expensive, bevacizumab plus capecitabine shows a clinical benefit over no maintenance and can be considered for routine use,” Dr. Maughan said. ■

Disclosure: Dr. Maughan has been a consultant or advisor for Sanofi and has received research funding from Merck Serono.


1. Koeberle D, Betticher DC, Von Moos R, et al: Bevacizumab continuation versus no continuation after first-line chemo-bevacizumab therapy in patients with metastatic colorectal cancer: A randomized phase III noninferiority trial (SAKK 41/06). 2013 ASCO Annual Meeting. Abstract 3503. Presented June 1, 2013.

2. Chibaudel B, Maindrault-Goebel F, Lledo G, et al: Can chemotherapy be discontinued in unresectable metastatic colorectal cancer? The GERCOR OPTIMOX2 Study. J Clin Oncol 27:5727-5733, 2009.

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