Aflibercept in metastatic colorectal cancer (mCRC): Data from clinical trials, lessons from clinical practice — ASN Events
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Aflibercept in metastatic colorectal cancer (mCRC): Data from clinical trials, lessons from clinical practice (#424)

Kynan Feeney 1 , Melvin Chin 2 , Siobhan Ng 3 , Marco Matos 4 , Gabriel Mak 2 , Joseph McKendrick 5
  1. Cancer Centre, St John of God Hospital, Murdoch, WA, Australia
  2. Prince of Wales Hospital, Randwick, NSW, Australia
  3. St John of God Private Hospital, Subiaco, WA, Australia
  4. Pacific Private Clinic, Southport, QLD, Australia
  5. Epworth Eastern Hospital, Box Hill, VIC, Australia

Aflibercept was registered in Australia, based on the VELOUR pivotal registration trial in second line mCRC.1 In VELOUR, the addition of aflibercept to FOLFIRI chemotherapy resulted in statistically significant increases in overall survival (OS, HR 0.82; median 12.1 vs 13.5 months), progression free survival (PFS, HR 0.76; median 4.7 vs 6.9 months), and response rate (ORR, 19.8% vs 11.1%). Clinical experience with aflibercept in Australia is now accumulating, enabling clinicians to begin to answer key clinical questions and share their experiences through case presentations.


1. Patient selection:
Decisions are further guided by patient-focused factors (disease status, tumour biology, performance status, KRAS mutation status, patient preferences, prior therapy, treatment goals) and practical factors (ease of access, costs, PBS listing).


2. Dose and duration of therapy:
In the VELOUR trial, aflibercept patients received a median of nine cycles overall (21.4 weeks). In practice, Australian clinicians aim to have a minimum of 2-3 months on treatment before re-staging to assess response. There is no maximum number of cycles provided the patient is deriving clinical benefit, is tolerating treatment and wishes to continue.
Standard approaches after stopping aflibercept would be to consider clinical trials, third-line treatment options including re-challenge with previous chemotherapy and targeted therapy, and cessation of systemic therapy.


3. Proactive management of adverse events
In VELOUR, adverse events (all grades) leading most frequently to permanent discontinuation of study treatment were asthenic conditions (3.8% v 1.3%, respectively), infections (3.4% v 1.7%), diarrhoea (2.3% v 0.7%), and hypertension (2.3% v 0%).
Adverse events are well documented. They can be minimised through proactive management strategies, making sure they are known to all staff involved in patient care and providing adequate patient education.


Funding: Editorial support for this abstract was provided by Hazel Palmer (Scius Solutions Pty Ltd) and funded by Sanofi Australia Pty Ltd.

  1. Van CE, et al. J Clin Oncol 2012 October 1;30(28):3499-3506.
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