Bevacizumab in combination with irinotecan, 5-fluorouracil and leucovorin given as first-line treatment of metastatic colorectal cancer.

Colorectal cancer (CRC) occurs predominantly in older people. It is the second leading cause of death from cancer among adults. Statistical power to assess risk/benefit from treatment in older patients is not different from that in younger patients. We report here the clinical benefit of bevacizumab plus 5-fluorouracil-based chemotherapy as first-line treatment in a 74-year-old female patient with metastatic CRC. The patient was admitted into a private hospital in November 2007 because of intestinal obstruction and ascites. Diagnosis was colon cancer clinical stage IV. She received the 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) regimen plus bevacizumab from January until July 2008. Toxicities were manageable. Because of the excellent response she had a re-laparotomy to restore bowel transit. Currently, she continues to use maintenance bevacizumab. This case report illustrates the possibility of adding bevacizumab to FOLFIRI in order to improve survival in patients with metastatic CRC. An analysis of pooled cohorts of patients aged 65 years and older from two similar trials in metastatic CRC has indicated that adding bevacizumab to 5-fluorouracil-based chemotherapy improved overall survival and progression-free survival similar to the benefits observed in younger patients. Also, the risks of treatment do not seem to exceed those in younger patients with metastatic CRC.