Stop and go FOLFOX plus bevacizumab chemotherapy in the first-line treatment of metastatic colorectal cancer

Background: Infusional 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX) plus bevacizumab chemotherapy is commonly implemented in the first-line treatment of metastatic colorectal cancer. A stop and go oxaliplatin strategy has been recommended to reduce oxaliplatin-associated neuropathy. Despite the acceptance of this strategy by community and academic practices, efficacy data with this approach are limited. Methods: We analyzed the efficacy of a stop and go FOLFOX regimen combined with bevacizumab in a single institute between January 2007 and December 2009. Oxaliplatin was withdrawn electively after 8 cycles of treatment and patients were maintained on 5-fluorouracil/leucovorin and bevacizumab until progression. When feasible, patients were rechallenged with oxaliplatin upon progression. Results: Sixty-seven patients were treated and analyzed for outcome. The response rate of this group was 58%. The median progression-free and overall survival was 10.6 and 26.7 months, respectively. The median duration of disease control in the 18-patient subgroup that was rechallenged with oxaliplatin was 21.2 months. Conclusions: Elective withdrawal of oxaliplatin after 8 cycles in the setting of FOLFOX and bevacizumab does not appear to compromise the activity of this regimen. A stop and go approach of FOLFOX plus bevacizumab is effective and may reduce treatment costs and toxicity in comparison with a continuous FOLFOX treatment strategy.